A home health nurse is visiting a client who has a new diagnosis of diabetes mellitus. Which of the following actions should the nurse take first?
Teach the client about appropriate food choices.
Refer the client to a diabetes mellitus support group.
Identify the client's dietary preferences.
Develop a nutritional program.
The Correct Answer is C
Choice A reason: Teaching the client about appropriate food choices is an important intervention for diabetes mellitus, but it is not the first action the nurse should take. The nurse needs to assess the client's current dietary habits and preferences before providing education.
Choice B reason: Referring the client to a diabetes mellitus support group is a helpful strategy to promote coping and self-management, but it is not the first action the nurse should take. The nurse needs to address the client's immediate needs and priorities before making referrals.
Choice C reason: Identifying the client's dietary preferences is the first action the nurse should take. This is an assessment step that will help the nurse tailor the nutritional program to the client's individual needs and preferences. It will also help the nurse establish rapport and trust with the client.
Choice D reason: Developing a nutritional program is a planning step that requires assessment data. The nurse should not develop a nutritional program without first identifying the client's dietary preferences and needs.
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Related Questions
Correct Answer is B
Explanation
Choice A reason: This statement is false and discouraging. The caregiver may be eligible for financial assistance for dementia from various sources, such as Medicare, Medicaid, or private insurance.
Choice B reason: This statement is true and supportive. The caregiver may benefit from finding a local support group for caregivers, where they can share their experiences, learn coping strategies, and access resources.
Choice C reason: This statement is unrealistic and harmful. The caregiver should not isolate themselves or their partner from other sources of support. The caregiver may need to delegate some tasks to other family members, friends, or professional caregivers.
Choice D reason: This statement is unreasonable and exhausting. The caregiver should not take over all the activities of daily living (ADLs) for their partner, as this may undermine their partner's autonomy and dignity. The caregiver should encourage their partner to perform ADLs as much as possible, with assistance as needed.
Correct Answer is D
Explanation
Choice A reason: The anthrax vaccine is ineffective following direct anthrax exposure is not a correct piece of information to include in the protocol. The anthrax vaccine can provide some protection against anthrax if given before exposure, but it cannot prevent or treat anthrax infection after exposure¹.
Choice B reason: Manifestations of anthrax infection appear within 3 days of exposure is not a correct piece of information to include in the protocol. The incubation period of anthrax varies depending on the route of exposure, but it can range from one day to several weeks. Inhalation anthrax usually has an incubation period of one to six days, but it can be longer².
Choice C reason: Prophylactic treatment should be provided to clients for 10 days following exposure to anthrax is not a correct piece of information to include in the protocol. Prophylactic treatment, or post-exposure prophylaxis (PEP), is the use of antibiotics to prevent anthrax infection in people who have been exposed to anthrax spores but do not have symptoms. PEP should be given for at least 60 days, or until the person receives three doses of the anthrax vaccine³.
Choice D reason: Ciprofloxacin should be administered to asymptomatic clients who were directly exposed to anthrax is a correct piece of information to include in the protocol. Ciprofloxacin is one of the antibiotics recommended by the CDC for PEP of anthrax. It can prevent anthrax infection in people who have inhaled anthrax spores but do not have symptoms. Ciprofloxacin should be given as soon as possible after exposure and continued for 60 days, or until the person receives three doses of the anthrax vaccine..
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