A nurse in a long-term care facility is implementing a nutrition plan for a client who is at risk for malnutrition. Which of the following actions should the nurse include in the plan? (Select all that apply.)
Remove the bedpan from the client's sight.
Assess for pain prior to mealtime.
Administer antiemetics following the meal.
Discourage snacks between meals.
Provide mouth care before feeding.
Correct Answer : B,E
A. Removing the bedpan from the client's sight is not directly related to addressing malnutrition risk.
B. Assessing for pain prior to mealtime is important because pain can interfere with appetite and eating, contributing to malnutrition.
C. Administering antiemetics following the meal may address nausea or vomiting, but it does not address the underlying factors contributing to malnutrition.
D. Discouraging snacks between meals may not be appropriate for all clients at risk for malnutrition, especially if they have poor oral intake during meals. Snacks may be necessary to provide additional nutrition and calories.
E. Providing mouth care before feeding helps improve oral hygiene, which can enhance the client's appetite and ability to eat.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Eating a larger meal at breakfast and smaller meals throughout the day can help regulate appetite, reduce overall caloric intake, and promote weight loss.
B. Setting a weight loss goal of 2.5 pounds per week may be unrealistic or unsafe for some individuals. A more moderate and sustainable goal, such as 1-2 pounds per week, is typically recommended.
C. Meal replacement shakes can be a convenient option for some individuals as part of a weight loss plan, but they do not inherently cause weight gain. However, it's important to choose meal replacements with appropriate nutritional content and to use them as part of a balanced diet.
D. Drinking water with meals can help promote satiety and may prevent overeating, but it is not the only behavioral modification necessary for successful weight loss.
Correct Answer is A
Explanation
A. A heart rate of 118/min suggests tachycardia, which is a compensatory mechanism in response to fluid volume deficit. The body increases heart rate to maintain cardiac output when fluid volume is low.
B. A central venous pressure of 25 mm Hg may indicate fluid volume overload rather than deficit. It suggests increased venous pressure, possibly due to excess fluid.
C. A blood pressure of 152/90 mm Hg is within the normal range and does not specifically indicate fluid volume deficit.
D. A temperature of 37.2°C (99°F) is within the normal range and does not specifically indicate fluid volume deficit.
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