Choice A rationale: Referring the client to a dietitian for nutrition education is a proactive step. Dietitians can provide personalized guidance and address the client's dietary concerns and preferences. However, this alone may not be sufficient if the client is strongly resistant to dietary changes.

Choice B rationale: Providing pamphlets about heart-healthy diet selections is informative but may not effectively address the client's resistance to dietary changes. The client's reluctance needs to be explored and addressed through a more interactive approach.

Choice C rationale: While exercise is important for heart health, the primary concern here is the client's elevated cholesterol levels, which are significantly impacted by dietary choices. Suggesting exercise alone may not adequately address the issue at hand.

Choice D rationale: Discussing the client's concerns about the change in diet is the most appropriate initial action. It allows the nurse to understand the client's perspective, identify barriers to compliance, and work collaboratively with the client to develop a plan that considers his preferences and challenges. This approach is more likely to lead to a successful change in diet and lifestyle compared to simply providing information or referrals.

Choice A: Flavored gelatin can be a choice if the client enjoys it, but it should not be the primary source of nutrition as it lacks protein and other essential nutrients needed for healing.
Choice B: Eggs are a good source of protein, which is essential for tissue repair and healing.
Choice C: Soda crackers are low in protein and do not provide adequate nutrition for postoperative healing.
Choice D: Baked chicken is a lean source of protein and can be a part of a balanced postoperative diet.
Choice E: Salmon is rich in omega-3 fatty acids and protein, which can support the healing process and provide essential nutrients.

Choice A: have higher sodium content, so they are not the best choices for someone with elevated serum sodium levels.

Choice B: have higher sodium content, so they are not the best choices for someone with elevated serum sodium levels.

Choice C: Skim milk, grapes, and lettuce are good sources of water that can help dilute the sodium level in the blood. Bacon is a high-sodium food, but it is a small portion compared to the other choices and can be balanced by the rest of the meal.

Choice D: this combination contains higher sodium levels, especially canned soup, so it's not the ideal choice.

Choice A: Uremic frost is a symptom of advanced kidney disease and can result in deposits of urea crystals on the skin. This can cause itching and discomfort, making it difficult for the client to maintain good hygiene and self-care. Therefore, addressing hygiene self-care deficit related to uremic frost is a priority in the plan of care for a client with renal osteodystrophy.

Choice B: This is not directly related to renal osteodystrophy and is more related to the presence of a catheter.

Choice C: This is not typically associated with renal osteodystrophy unless there are specific mobility issues related to bone problems.

Choice D: This may be relevant for clients with CKD, but it is not specific to renal osteodystrophy, which primarily involves bone mineral imbalances.

Choice A: This is not specifically related to the side effects of phenytoin.

Choice B: This is not directly related to the common side effects of phenytoin, which primarily affect the oral cavity.

Choice C: Phenytoin (Dilantin) is known to cause gingival hyperplasia (enlargement of the gums) as a common side effect. The nurse should regularly inspect the client's mouth to monitor for this adverse effect.

Choice D: This is not specifically relevant to monitoring for phenytoin's side effects.

Choice A: This is important for the client's overall health but is not the most immediate priority in managing diabetes.

Choice B: The most important intervention for this client is to address lifestyle factors that contribute to diabetes and overall health. Weight loss and dietary changes are key components of managing type 2 diabetes. The client's weight is significantly above a healthy range, and losing 2 pounds (1 kg) per week is a reasonable and safe goal.

Choice C: Encouraging family members to be tested for diabetes is relevant but does not directly address the client's own management of the condition.

Choice D: Determining the client's feelings about the diagnosis is important for emotional support but does not directly address the client's physical health and diabetes management.

Choice A: This response indicates an understanding of the need to avoid high- risk activities that could worsen the condition or cause injury to the affected leg, which is appropriate after acute osteomyelitis.

Choice B: While exercise is important, it should be done under medical guidance, especially after a significant illness like acute osteomyelitis.

Choice C: Resuming normal activities may not be appropriate immediately, and the level of activity should be determined by the healthcare provider.

Choice D: Keeping the leg immobile is not typically recommended as it can lead to muscle atrophy and other complications.

Choice A: A high protein diet is generally not recommended for clients with glomerulonephritis, as it can put additional strain on the kidneys.

Choice B: In glomerulonephritis, there is impaired kidney function, and sodium and fluid restrictions are often necessary to manage fluid balance and blood pressure.

Therefore, the nurse should instruct the client to restrict sodium-rich foods and excessive oral fluids.

Choice C: A low carbohydrate diet with low glycemic index foods is not a specific dietary recommendation for managing glomerulonephritis.

Choice D: Dietary potassium restriction may vary depending on the individual client's potassium levels and needs, so it should be determined by the healthcare provider. It is not a blanket recommendation for all clients with glomerulonephritis.

Choice A: Permethrin cream may cause temporary itching and skin irritation as it works to eliminate the scabies mites. Instructing the client to remove the cream immediately if pruritis occurs is not necessary; it is a common and expected side effect during treatment.

Choice B: Reapplication of permethrin is not typically done in seven days unless directed by the healthcare provider. A single application is often effective in treating scabies.

Choice C: Showering or bathing 8 to 14 hours after permethrin treatment is a common instruction to remove the cream and dead mites. This is an important part of the treatment process.

Choice D: Avoiding areas between fingers and toes during application is not necessary, as permethrin is generally safe for use on these areas. However, it should not be applied to the face or near the eyes.

A. Document the findings in the record – A bluish-black discoloration over the lumbosacral area is most likely a Mongolian spot, a benign congenital birthmark commonly seen in infants with darker skin tones. It does not require intervention, only documentation.
B. Report possible child abuse to protective services – Mongolian spots may resemble bruises, but they are not a sign of abuse. Reporting without further assessment is inappropriate.
C. Gently rub the area with skin cream to promote healing – Mongolian spots are not injuries and do not require treatment.
D. Ask the mother about the discoloration – While obtaining history is important, Mongolian spots are well-known benign findings that do not require further clarification from the parent.