Exhibits
The nurse reviews the client's data.
Choose the most likely options for the information missing from the sentence by selecting from the lists of options provided.
The client's assessment findings of
The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"B"}
The client's assessment findings of neuropathy and incontinence place him at a high risk for multiple other health issues and require immediate follow-up by the nurse.
Rationale:
Neuropathy. The client reports neuropathy in both hands and lower legs. Neuropathy leads to decreased sensation, increasing the risk of falls, pressure injuries, and unnoticed wounds, which can become severe due to diabetes-related poor healing. It also contributes to mobility limitations, further affecting the client’s safety and independence.
Incontinence. The client experiences urinary and fecal incontinence due to difficulty moving quickly enough to reach the bathroom. Incontinence increases the risk of skin breakdown, infections, and pressure ulcers, especially since the client has mobility issues and spends prolonged time sitting.
Moist skin. While moist skin may suggest sweating or autonomic dysfunction, it is not as significant a risk factor as neuropathy and incontinence, which directly impact skin integrity and mobility.
Coarse lung sounds. Coarse lung sounds may indicate fluid retention or respiratory congestion, but they are not as immediately concerning as neuropathy and incontinence, which increase the risk for skin damage, infection, and functional decline.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Lordosis. Lordosis (excessive inward curvature of the lower spine) is not a normal part of aging. It is more commonly associated with pregnancy, obesity, or certain musculoskeletal conditions rather than normal aging.
B. Barrel chest. A barrel chest (increased anteroposterior chest diameter) is commonly associated with chronic obstructive pulmonary disease (COPD), not normal aging. While lung compliance decreases with age, a barrel chest is not a typical age-related change.
C. Pectus excavatum. Pectus excavatum (a sunken or concave chest) is a congenital chest wall deformity and is not related to aging.
D. Kyphosis. Kyphosis (excessive outward curvature of the upper spine, leading to a hunched posture) is a normal age-related change due to bone density loss, vertebral compression, and degenerative changes in the spine. It is more common in older adults, especially those with osteoporosis.
Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"B"}
Explanation
Rationale:
- Calculate total fat calories for each day:
- Day 1: 24×38=91224 \times 38 = 912 kJ
- Day 2: 22×38=83622 \times 38 = 836 kJ
- Day 3: 23×38=87423 \times 38 = 874 kJ
- Convert total daily calories to kJ:
- Day 1: 3,200×4.184=13,388.83,200 \times 4.184 = 13,388.8 kJ
- Day 2: 2,980×4.184=12,471.32,980 \times 4.184 = 12,471.3 kJ
- Day 3: 3,310×4.184=13,841.03,310 \times 4.184 = 13,841.0 kJ
- Calculate fat percentage:
- Day 1: (912/13388.8)×100=18.2%
- Day 2: (836/12471.3)×100=17.1%
- Day 3: (874/13841.0)×100=17.3%
Average fat percentage: (18.2+17.1+17.3)/3=17.5%
- Interpretation:
- The recommended fat intake range is 20-35% of total calories.
- The client's fat intake is 14-19%, which is below the recommended range.
- The client should increase his fat intake to meet nutritional needs.
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