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During a home health visit, the nurse observes that an elderly client with type 2 diabetes mellitus is wearing loose cloth slippers.
The client reports discomfort when wearing other shoes due to long toenails.
Upon inspection, the nurse finds long, thick nails that curl under some of the client’s toes. What should the nurse do in this situation?

Demonstrate proper foot care to the client and family.

Gradually trim the client’s toenails over several visits.

Arrange for a home health aide to assist the client with hygiene weekly.

Schedule an appointment for the client with a podiatrist.

Answer and Explanation

The Correct Answer is D

Answer and explanation

The correct answer is Choice D.

Choice A rationale

While demonstrating proper foot care is important, this client’s situation requires immediate attention. Long, thick nails that curl under the toes can lead to complications such as ulcers, infections, and pain.

Choice B rationale

Gradually trimming the client’s toenails over several visits may not be the best approach. The client’s long, thick nails are causing discomfort and could lead to more serious complications.

Choice C rationale

Arranging for a home health aide to assist the client with hygiene weekly could be part of a long-term plan, but it does not address the immediate issue of the client’s long, thick toenails.

Choice D rationale

Scheduling an appointment for the client with a podiatrist is the best option. A podiatrist is a healthcare professional who specializes in foot care. They can safely trim the client’s long, thick toenails and assess for any other foot-related issues.

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Correct Answer is D

Explanation

Answer and explanation

The correct answer is Choice D.

Choice A rationale

Reviewing the child's medical history for any allergies or sensitivities is always a good practice during a routine check-up³?³?³?³?. However, in this case, the child's symptoms of difficulty focusing in school and decreased appetite may not necessarily be related to allergies or sensitivities. These symptoms could be indicative of various conditions, including emotional distress, sleep disorders, or other health issues²².

Choice B rationale

Examining the child's torso and arms for any signs of physical trauma is an important step if there is suspicion of physical abuse³?[^40^]?¹?². However, the symptoms described by the mother do not necessarily suggest physical trauma. Therefore, while a physical examination is part of a routine check-up, it may not directly address the child's reported symptoms.

Choice C rationale

Permethrin is a medication used to treat scabies and lice¹³¹?. There is no indication in the scenario provided that the child has these conditions. Therefore, advising the parents to initiate treatment with permethrin would not be appropriate based on the information given.

Choice D rationale

Given the child's symptoms of difficulty focusing in school and decreased appetite, it would be appropriate to recommend the parents to seek further medical evaluation for the child²?²?²?. These symptoms could be indicative of various conditions, including emotional distress, sleep disorders, or other health issues, which would require further investigation²².

A. Potassium level of 3.7 mEq/L (3.7 mmol/L). B. B-type natriuretic peptide (BNP) level of 550 pg/mL (550 ng/L). C. Total cholesterol level of 190 mg/dL (4.92 mmol/L). D. Glycosylated hemoglobin (A1C) level of 7%.

Correct Answer is B

Explanation

Answer and explanation

The correct answer is Choice B.

Choice A rationale

A potassium level of 3.7 mEq/L (3.7 mmol/L) is within the normal range, which is typically between 3.6 and 5 mEq/L12. Therefore, this result does not need to be reported immediately to the healthcare provider.

Choice B rationale

B-type natriuretic peptide (BNP) levels are used to diagnose and monitor heart failure. A BNP level of 550 pg/mL (550 ng/L) is significantly higher than the normal range, which is less than 100 pg/mL34. High BNP levels indicate that the heart is working harder than normal, which is a common occurrence in heart failure. Therefore, this result should be reported immediately to the healthcare provider.

Choice C rationale

A total cholesterol level of 190 mg/dL (4.92 mmol/L) is considered borderline high. While it’s important to manage cholesterol levels in patients with heart failure, this result is not critical and does not need to be reported immediately to the healthcare provider.

Choice D rationale

A glycosylated hemoglobin (A1C) level of 7% is at the threshold for the diagnosis of diabetes. Diabetes can complicate the management of heart failure and increase the risk of cardiovascular events. However, this result is not critical and does not need to be reported immediately to the healthcare provider.

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Naxlex Comprehensive Predictor Exams

A 5-year-old patient has been brought in for a routine check-up and vaccination update.The mother reports that the child has been having difficulty focusing in school and has shown a decreased appetite in recent weeks.What actions should the nurse take?

Correct Answer is D

Explanation

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Correct Answer is B

Explanation

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