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Exhibits

Which item(s) should the nurse teach the client? Select all that apply.

Soaking baths for pain management

Circular wrapping of the residual limb

Prevention of skin breakdown

Therapeutic coping

Keeping a positive outlook

Use of equipment

Fine motor skills

Alternating positions

Answer and Explanation

Correct Answer : B,C,D,F,H

A. Soaking baths for pain management: Soaking the residual limb is generally discouraged post-amputation due to the risk of infection and skin maceration. The surgical site should be kept clean and dry, using moist gauze for cleaning as ordered, rather than immersing the limb in water.

B. Circular wrapping of the residual limb: Teaching the client how to perform circular wrapping of the residual limb promotes proper shaping for prosthetic fitting and helps prevent edema. This wrapping also provides support and reduces skin irritation during the healing phase.

C. Prevention of skin breakdown: Clients with reduced mobility and altered sensation—especially those with a history of vascular disease—are at high risk for pressure injuries. Teaching repositioning, inspection of pressure points, and skin hygiene is essential to preserve skin integrity.

D. Therapeutic coping: Amputation can have a profound psychological impact. Teaching and encouraging therapeutic coping strategies, such as guided imagery, journaling, or referral to counselling, helps the client emotionally adjust to body image changes and functional loss.

E. Keeping a positive outlook: While maintaining optimism is helpful, it is not a specific teaching point. It is more of an attitude that may be nurtured through supportive interventions rather than directly taught as part of discharge or rehabilitation education.

F. Use of equipment: Clients need education on safely using assistive devices such as walkers, wheelchairs, or prosthetic aids. Instruction on equipment helps promote independence and safety during mobility and self-care tasks.

G. Fine motor skills: These are not typically affected by a lower extremity amputation and do not require targeted teaching unless another condition is present. Focus should remain on gross motor functions and adaptation to mobility aids.

H. Alternating positions: Teaching the client to alternate positions, including use of the prone position as ordered, helps prevent hip contractures, improves circulation, and reduces pressure on any one area. Positioning strategies are crucial for both comfort and long-term functional outcomes.

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Free Nursing Study Resources

Correct Answer is A

Explanation

A. Breathe deeply, followed by coughing up the sputum: Deep breathing expands the lungs and loosens secretions from the lower respiratory tract, which helps produce a more accurate sputum specimen. Forceful coughing after deep inhalation brings up mucus from the bronchi rather than saliva from the mouth, ensuring specimen quality for diagnostic testing.

B. Avoid mouth care prior to collecting the sputum: Performing mouth care before sputum collection is actually recommended to reduce contamination by oral bacteria and debris. Omitting oral hygiene may result in a specimen that includes non-respiratory secretions, compromising its diagnostic value.

C. Restrict fluids before expectorating the sputum specimen: Hydration helps thin respiratory secretions, making it easier to expectorate sputum. Fluid restriction can lead to thick, tenacious mucus, which is more difficult to collect and may result in an inadequate sample.

D. Obtain the specimen before bedtime: Sputum is generally more concentrated and easier to collect in the morning after secretions have pooled overnight. Evening collection may yield less volume and lower-quality specimens, reducing the reliability of the test results.

A. Limit calories on days unable to exercise. B. Regular exercise with medical approval. C. Monitor blood glucose levels daily. D. Monthly appointments with the dietician.

Correct Answer is B

Explanation

A. Limit calories on days unable to exercise: While adjusting caloric intake is a useful strategy in managing blood glucose, inconsistent caloric restriction without a structured plan can lead to hypoglycemia or poor nutritional intake. This approach alone is insufficient for improving HDL levels, which are influenced more significantly by physical activity.

B. Regular exercise with medical approval: Engaging in consistent aerobic exercise enhances insulin sensitivity, helping to lower blood glucose levels. Physical activity also promotes cardiovascular health by raising HDL cholesterol, which offers protective benefits against atherosclerosis—an important concern in diabetic clients.

C. Monitor blood glucose levels daily: Daily glucose monitoring is essential for adjusting treatment and preventing complications, but it does not directly increase HDL levels. Monitoring provides data, but behavior changes like diet and exercise are what actively influence these health markers.

D. Monthly appointments with the dietician: Regular consultation with a dietitian supports nutritional management, but monthly visits may not have a timely or sufficient impact on HDL and glucose control. Lifestyle modifications, particularly regular exercise, offer more immediate and measurable effects in both areas.

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Exhibits Which item(s) should the nurse teach the client? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is teaching a client how to collect a sputum specimen. Which steps should the nurse instruct the client to follow when collecting a sputum?

Correct Answer is A

Explanation

The nurse is developing a plan of care for a client with type 2 diabetes mellitus (DM). When providing teaching on lowering blood glucose levels and increasing serum high-density lipoprotein (HDL) levels, which instruction should the nurse include?

Correct Answer is B

Explanation

A client with eczema is applying 10% urea cream onto the affected skin areas. Which finding reflects the expected therapeutic response?

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Exhibits

Which item(s) should the nurse teach the client? Select all that apply.