Patient Data

Exhibits

For each client activity, click to indicate whether the activity shows positive or negative health promotion postamputation due to extensive peripheral vascular disease.

Inquires about blood pressure

Asks questions about self-care

Requests nurse to perform wound care

Executes pull-ups on trapeze bar

Avoids looking at residual limb

Turns side to side

Answer and Explanation

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

Positive health promotion activities include inquiring about blood pressure, asking questions about self-care, executing pull-ups on a trapeze bar, and turning side to side.

Negative health promotion activities include requesting the nurse to perform wound care and avoiding looking at the residual limb.

Rationale

POSITIVE:

Inquires about blood pressure:

Inquiring about blood pressure shows awareness of cardiovascular health, which is important for individuals with peripheral vascular disease. Monitoring blood pressure regularly can help prevent complications and manage hypertension, a common comorbidity in peripheral vascular disease.

Asks questions about self-care:

Asking questions about self-care indicates engagement in the management of one's health post- amputation. Understanding self-care tasks, such as wound care, prosthetic use, and rehabilitation exercises, is crucial for optimal recovery and adjustment to life after amputation. Executes pull-ups on trapeze bar:

Engaging in physical activity, such as pull-ups on a trapeze bar, demonstrates motivation for rehabilitation and adaptation to life after amputation. Strengthening exercises can improve overall physical function and assist in adjusting to mobility with a prosthetic limb.

Turns side to side:

Turning side to side suggests mobility and activity post-amputation. Movement and repositioning are important for preventing complications such as pressure ulcers and promoting circulation in individuals with peripheral vascular disease.

NEGATIVE

Requests nurse to perform wound care:

Negative: While it's understandable for a client to initially require assistance with wound care post-amputation, relying solely on the nurse to perform wound care may indicate a lack of engagement in self-management and may hinder the client's transition to independence in managing their health post-amputation.

Avoids looking at residual limb:

Negative: Avoiding looking at the residual limb may indicate psychological distress or difficulty accepting the amputation. It's important for individuals post-amputation to gradually become comfortable with their changed body image and to address any psychological challenges through counseling or support groups.

Nursing Test Bank

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Naxlex Comprehensive Predictor Exams

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Free Nursing Study Resources

Correct Answer is D

Explanation

A. Releasing traction to use a bedpan may cause pain and discomfort to the client and risk exacerbating the fracture or compromising the alignment needed for surgery.
B. Log rolling the client and placing adult disposable briefs beneath them may not be suitable because it involves movement that can disrupt traction and worsen the client's pain.
Additionally, disposable briefs may not adequately manage urinary output, especially for a client awaiting surgery.

C.While using a catheter can be an option, it is generally not the first intervention unless the client is unable to void by other means or has a specific indication for catheterization. It carries risks, including infection, and should be considered carefully.
D. The nurse can assist the client in using a urinal while ensuring that traction is maintained. This allows the client to urinate without disrupting the traction setup, minimizing the risk of complications associated with the fracture.

A. Take a cinnamon supplement B. Eliminate sugary beverages and juices from the diet C. Increase the amount of dietary fiber D. Only select food items with no fat E. Double the usual amount of protein in the diet F. Minimize the number of refined grains in the diet

Correct Answer is ["B","C","F"]

Explanation

B. Sugary beverages and juices are major sources of added sugars and can contribute to weight gain, insulin resistance, and an increased risk of type 2 diabetes mellitus. By eliminating these beverages from the diet, the client can reduce their intake of empty calories and excess sugars, which may help improve blood sugar control and reduce the risk of diabetes.
C. Fiber-rich foods, such as fruits, vegetables, whole grains, and legumes, can help improve blood sugar control, promote satiety, and support weight management. Fiber also helps regulate bowel movements and may reduce the risk of developing type 2 diabetes mellitus.
F. Refined grains, such as white bread, white rice, and sugary cereals, have been stripped of their fiber and nutrients during processing, leading to rapid spikes in blood sugar levels. Minimizing the intake of refined grains and opting for whole grains instead can help stabilize blood sugar levels, improve insulin sensitivity, and reduce the risk of type 2 diabetes mellitus.
A. While some studies have suggested that cinnamon may have beneficial effects on blood sugar control, the evidence is limited and inconsistent. Additionally, taking high doses of cinnamon supplements may not be safe for everyone, particularly those with liver disease or taking certain medications.
D. While reducing intake of unhealthy fats, such as saturated and trans fats, is important for overall health and reducing the risk of heart disease, eliminating all fats from the diet is unnecessary and potentially harmful. Healthy fats, such as those found in nuts, seeds, avocados, and olive oil, are essential for nutrient absorption, hormone production, and overall well-being.
E. Increasing protein intake significantly may not be necessary or advisable for this client, especially without knowing their specific dietary needs and preferences. While protein is an important macronutrient for muscle repair and maintenance, doubling the usual amount of protein in the diet may not offer additional benefits and could potentially lead to imbalances in other nutrients.

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Patient Data Exhibits For each client activity, click to indicate whether the activity shows positive or negative health promotion postamputation due to extensive peripheral vascular disease.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client who fractured the right femur from a fall at home is placed in traction while awaiting surgery. When the client informs the nurse of the need to urinate, which intervention should the nurse implement?

Correct Answer is D

Explanation

Patient Data Exhibits Review H and P, nurse's note, and laboratory results. What other nutritional recommendation(s) would be helpful for this client in reducing risk for type 2 diabetes mellitus? Select all that apply.

Correct Answer is ["B","C","F"]

Explanation

Review H and P, nurse's note, and laboratory results. Click to mark whether the client statement indicates understanding or no understanding of the education given

A client experiencing a sudden onset of confusion and trouble speaking at home is transported to the emergency department. The client does not understand simple commands and appears very frustrated. Which intervention should the nurse perform in the immediate management of the client?

The nurse is evaluating a client's understanding of diet teaching about the DASH (Dietary Approaches to Stop Hypertension) eating plan. Which behavior indicates that the dient is adhering to the eating plan?

Review Hand P and laboratory results Exhibits What item(s) should be included in the treatment regimen for this client? Select all that apply.

The nurse is caring for a client with chemotherapy induced mucositis who is describing soreness of the tongue and oral tissues. Which is the best initial nursing action?

A client who had a biliopancreatic diversion procedure (BDP) 3 months ago is admitted with severe dehydration. Which assessment finding warrants immediate intervention by the nurse?

Patient Data Exhibits Based on the laboratory data, the client has dropdown related to dropdown

Patient Data

Exhibits

For each client activity, click to indicate whether the activity shows positive or negative health promotion postamputation due to extensive peripheral vascular disease.