Exhibits

For each potential nursing action, click to indicate whether the action is indicated, contraindicated, or nonessential for this client's plan of care. Each row must have only one option selected.

Instruct incentive spirometry use every hour.

Encourage consumption of protein and vitamin C.

Apply thromboembolism deterrent stockings (TED).

Use Petroleum based lotion on legs

Answer and Explanation

The Correct Answer is {"A":{"answers":"C"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"B"}}

Instruct incentive spirometry use every hour (Nonessential): There is no indication of respiratory compromise, so incentive spirometry is not a priority for this client.

Encourage consumption of protein and vitamin C (Indicated): These nutrients support wound healing and immune function, which are important in managing infection and preventing further complications.

Apply thromboembolism deterrent stockings (TED) (Contraindicated): TED stockings may worsen symptoms if the client has cellulitis or a deep vein thrombosis (DVT), as compression can increase pain and impede circulation in an already swollen and inflamed limb.

Use petroleum-based lotion on legs (Contraindicated): Petroleum-based products can trap moisture and create an environment for bacterial growth, which is not suitable for a client with cellulitis or diabetes. Instead, a diabetic-safe moisturizer should be used while avoiding open wounds.

Nursing Test Bank

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Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

A. Crohn's disease. Crohn’s disease is a chronic inflammatory bowel disease that affects nutrient absorption, leading to malnutrition. It can cause diarrhea, abdominal pain, and intestinal damage, reducing the body's ability to absorb essential nutrients such as proteins, vitamins, and minerals. Clients may also have anorexia and weight loss due to inflammation and malabsorption.
B. Gastroesophageal reflux. Gastroesophageal reflux disease (GERD) can cause discomfort and lead to dietary modifications, but it does not directly cause severe malnutrition. Clients may avoid certain foods, but overall nutrient absorption remains intact.
C. Cholecystitis. Cholecystitis (inflammation of the gallbladder) primarily affects fat digestion. While clients may experience discomfort with fatty foods, it does not typically lead to widespread malnutrition.
D. Diverticulosis. Diverticulosis is usually asymptomatic and does not impair nutrient absorption. While dietary fiber intake is important to prevent complications like diverticulitis, this condition does not pose a high risk for malnutrition compared to Crohn’s disease.

A. Scrambled eggs with roasted peppers and onions, lean ham, and toast. B. Pancakes with blueberries and maple syrup, and a turkey sausage patty. C. Oatmeal with raisins and nuts, with skim milk and 1/2 grapefruit. D. Poached egg, bacon, biscuit and canned peaches in light syrup.

Correct Answer is C

Explanation

A. Scrambled eggs with roasted peppers and onions, lean ham, and toast. While peppers and onions provide antioxidants, the presence of processed meat (ham) increases the risk of some cancers, particularly colorectal cancer, due to nitrates and preservatives.
B. Pancakes with blueberries and maple syrup, and a turkey sausage patty. Blueberries are rich in antioxidants, which can help reduce cancer risk, but pancakes with syrup are high in refined carbohydrates and added sugars, which may contribute to inflammation and increased cancer risk.
C. Oatmeal with raisins and nuts, with skim milk and 1/2 grapefruit. Oatmeal contains fiber, which helps reduce the risk of colorectal cancer. Raisins and nuts provide antioxidants, while grapefruit is high in vitamin C, which supports immune function and may help protect against some cancers. This is the best balanced meal with cancer-protective nutrients.
D. Poached egg, bacon, biscuit, and canned peaches in light syrup. Bacon is a processed meat linked to an increased risk of colorectal cancer. Biscuits are refined carbohydrates, and canned peaches in syrup contain added sugars, which can contribute to inflammation and chronic disease risk.

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Exhibits For each potential nursing action, click to indicate whether the action is indicated, contraindicated, or nonessential for this client's plan of care. Each row must have only one option selected.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is assessing the nutritional status of a group of clients in a long term care facility. Which pathophysiological process poses the highest risk for malnutrition in this population?

Correct Answer is A

Explanation

The nurse is conducting a nutritional class on foods that have been linked to help decrease the development of some forms of cancer. Which meal selection is the best choice to help reduce the risk of some cancers?

Correct Answer is C

Explanation

The nurse is developing a workshop on cancer prevention for a group of adults at a wellness fair. Which recommendation should the nurse include in the workshop?

In assisting the family of an older adult client to determine the best living environment for the client, which factor is most important for the nurse to consider?

An older adult client is admitted from a long-term care facility with purulent exudate draining from a sacral pressure ulcer is suspected to have methicillin-resistant Staphylococcus aureus (MRSA). Which nursing interventions should the nurse include in the plan of care? Select all that apply.

Which is the function of the keratinocytes, a type of skin cell?

An older adult client comes to a free vaccination clinic requesting an influenza vaccination. Which action should the nurse implement?

Exhibits Click to indicate which education instructions the nurse should include to prevent future cellulitis and promote healing when preparing the client for discharge. Each column must have at least one response selected.

The nurse is teaching a health promotion class for adults about the effects of sun exposure on skin. Which statement about the function of collagen is correct?

The nurse is talking with a couple at a community health fair who ask how cancerous tumors occur. Which pathophysiological process supports the nurse's reponse about cancer cells developement?

Exhibits

For each potential nursing action, click to indicate whether the action is indicated, contraindicated, or nonessential for this client's plan of care. Each row must have only one option selected.