A client who is obese reports severe pain and is unable to bear weight in the right ankle after making dietary changes 3 weeks ago for weight loss.
The client's medical history includes hypertension, gouty arthritis, and cholecystitis.
Which instruction should the nurse include in the discharge teaching?
Substitute natural fruit juices for carbonated drinks.
Encourage active range of motion to limit stiffness.
Use electric heating pad when pain is at its worst.
Avoid the consumption of wine, beer, and coffee.
The Correct Answer is B
Choice A rationale:
Substituting natural fruit juices for carbonated drinks may be a beneficial dietary change, but it does not address the client's immediate issue of severe pain and inability to bear weight on the right ankle. This choice does not directly address the client's current problem and should not be the priority instruction in discharge teaching.
Choice B rationale:
Encouraging active range of motion to limit stiffness is the most appropriate instruction in this situation. The client's inability to bear weight on the right ankle after making dietary changes may be related to musculoskeletal issues or gouty arthritis. Active range of motion exercises can help prevent stiffness and improve joint function.
Choice C rationale:
Using an electric heating pad when pain is at its worst may provide some comfort, but it does not address the underlying cause of the severe pain in the right ankle. It is important to address the cause of the pain rather than relying solely on symptom management.
Choice D rationale:
Avoiding the consumption of wine, beer, and coffee may be relevant for some medical conditions, but it does not directly address the client's current problem of severe ankle pain and inability to bear weight. It is not the most immediate concern.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
"Phobias are characterized by persistent and irrational fear" (Choice A) is an accurate statement. Phobias are defined by the presence of an intense and irrational fear of a specific object or situation. This fear is persistent and often leads to avoidance behaviors, which can significantly impact the individual's daily life.
Choice B rationale:
"Phobias can be caused by biological factors only" (Choice B) is an inaccurate statement. Phobias can have various causes, including both biological and psychological factors. While there may be genetic predispositions to certain phobias, psychological factors, such as traumatic experiences or learned behaviors, can also contribute to the development of phobias.
Choice C rationale:
"Phobias can be diagnosed based on physical symptoms" (Choice C) is an inaccurate statement. Phobias are typically diagnosed based on the individual's reported symptoms, such as intense fear and avoidance behaviors. There are no specific physical symptoms that directly indicate the presence of a phobia.
Choice D rationale:
"Phobias can be managed with medication alone" (Choice D) is an inaccurate statement. Medication alone is not considered the primary treatment for phobias. While medications like selective serotonin reuptake inhibitors (SSRIs) or benzodiazepines may be prescribed to alleviate anxiety symptoms, the most effective treatment for phobias is psychotherapy, particularly exposure therapy or cognitive-behavioral therapy. These therapies address the root causes of the phobia and help individuals learn to manage their fear.
Correct Answer is ["21"]
Explanation
Let’s calculate the infusion rate step by step:
- Convert 1 liter to mL: 1 liter = 1000 mL.
- Calculate total infusion time in minutes: 12 hours = 12 × 60 = 720 minutes.
- Calculate the rate in mL/min: Rate = Total Volume ÷ Total Time = 1000 mL ÷ 720 min = 1.39 mL/min.
- Calculate the drip rate in gtt/min: Drip Rate = Rate (mL/min) × Drip Factor (gtt/mL) = 1.39 mL/min × 15 gtt/mL = 20.85 gtt/min.
If rounding is required, we round to the nearest whole number. So, the nurse should regulate the infusion to 21 gtt/min.
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