Which intervention should the nurse implement to manage a client’s fluid and electrolyte balance?

Choice A reason: Gluten avoidance is specific to celiac disease, not Crohn’s, which involves autoimmune inflammation of the gut. Crohn’s dietary triggers vary individually, and gluten is not a universal issue. An elimination diet identifies specific triggers, making this response incorrect for Crohn’s management.

Choice B reason: Fluid restriction is not a primary limitation in Crohn’s disease, which often requires adequate hydration due to diarrhea. Restricting fluids could worsen dehydration. An elimination diet to identify trigger foods is more appropriate, as dietary management focuses on individual sensitivities, not fluid limits.

Choice C reason: An elimination diet identifies trigger foods causing Crohn’s flare-ups, as sensitivities vary. By systematically removing and reintroducing foods, patients pinpoint irritants like dairy or fiber, personalizing dietary management. This is the most effective approach, as Crohn’s lacks universal dietary restrictions, making it the correct response.

Choice D reason: Limiting calcium and iron is not standard for Crohn’s, as these nutrients are often deficient due to malabsorption. Supplementation may be needed. An elimination diet better addresses symptom triggers, as nutrient restriction could exacerbate deficiencies without targeting inflammatory food triggers.

Choice A reason: Topical corticosteroids reduce inflammation, scaling, and itching in psoriasis by inhibiting pro-inflammatory cytokines and immune responses in affected skin. They are first-line for plaque psoriasis with silvery scales, effectively managing burning and promoting healing of inflamed, bleeding areas on elbows and palms.

Choice B reason: Topical analgesics relieve pain but do not address psoriasis’s underlying inflammation or scaling. Psoriatic plaques are primarily inflammatory, not neuropathic. Analgesics may reduce burning temporarily but lack the anti-inflammatory action of corticosteroids, making them ineffective for managing chronic psoriatic lesions.

Choice C reason: Topical antibiotics treat bacterial infections, not psoriasis, which is an autoimmune inflammatory condition. Bleeding in psoriasis results from skin fragility, not infection. Antibiotics are unnecessary unless secondary infection is confirmed, making them inappropriate compared to corticosteroids, which target the disease’s inflammatory pathology.

Choice D reason: Colloidal oatmeal-based lotion soothes irritated skin and reduces itching but lacks anti-inflammatory properties to treat psoriasis’s scaling and inflammation. It may provide symptomatic relief but is inadequate for managing chronic plaques, unlike corticosteroids, which directly address the autoimmune-driven inflammation and scaling.