A nurse is assessing the health literacy of an older adult client who has type 2 diabetes mellitus. Which of the following actions should the nurse take?

Ask the client how she feels about her understanding of diabetes.

Ask the client how often she reads food labels.

Ask the client to explain what she read from a brief handout about diabetes management.

Ask the client when she last had her HbA1c checked.

Answer and Explanation

The Correct Answer is C

A) Asking the client how she feels about her understanding of diabetes can provide some insight into her confidence and perceived knowledge. However, it does not objectively measure her actual understanding or ability to apply diabetes management information.

B) Asking the client how often she reads food labels assesses a specific behavior related to diabetes management but does not fully evaluate the client's overall health literacy. The frequency of reading food labels may indicate some level of engagement, but it does not necessarily reflect comprehensive understanding or effective diabetes self-management.

C) Requesting the client to explain what she read from a brief handout about diabetes management provides a direct assessment of her comprehension and retention of diabetes management information. This approach effectively measures her ability to understand and apply critical health information, which is a core component of health literacy.

D) Inquiring about the timing of her last HbA1c test assesses adherence to diabetes monitoring but does not gauge the client's understanding of diabetes management. While important, this question does not provide a clear picture of her health literacy or ability to manage her condition effectively.

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Free Nursing Study Resources

Correct Answer is D

Explanation

A) "Limit sodium intake to 3,500 milligrams per day.":
Limiting sodium intake is crucial for managing heart failure to prevent fluid retention and exacerbation of symptoms. However, the recommended limit is typically much lower, around 1,500 to 2,000 milligrams per day, not 3,500 milligrams.

B) "Take ibuprofen for discomfort.":
Ibuprofen and other NSAIDs are not recommended for clients with heart failure as they can cause fluid retention, worsen heart failure symptoms, and increase the risk of kidney problems. Alternatives such as acetaminophen are generally safer for pain relief.

C) "Increase the distance you walk by 100 feet daily, even if you feel fatigued.":
While regular exercise is important, clients with heart failure should not push through fatigue, as overexertion can lead to worsening symptoms. Exercise recommendations should be tailored to the individual's tolerance and should be adjusted based on their energy levels.

D) "Include no more than 2,000 milliliters of fluid intake in 24 hours.":
Restricting fluid intake to 2,000 milliliters per day helps prevent fluid overload, which is critical for managing heart failure. Monitoring and limiting fluid intake can help control symptoms such as edema and shortness of breath.

A. Provide a detailed account of the feelings and sounds the client will experience. B. Obtain a prescription for clonazepam. C. Obtain a prescription for ziprasidone. D. Inform the client that the time spent in the MRI machine will only be 5 min.

Correct Answer is B

Explanation

A) Provide a detailed account of the feelings and sounds the client will experience:
While explaining the procedure can be helpful, it might increase anxiety for someone with claustrophobia by focusing on potentially distressing details. It's more effective to use relaxation techniques or medications to manage acute anxiety.

B) Obtain a prescription for clonazepam:
Clonazepam, a benzodiazepine, can help reduce anxiety and is often used to manage claustrophobia during procedures like an MRI. This medication can help the client stay calm and more comfortable during the scan.

C) Obtain a prescription for ziprasidone:
Ziprasidone is an antipsychotic medication and is not typically used for managing situational anxiety or claustrophobia. Using an appropriate anxiolytic like clonazepam is more effective in this context.

D) Inform the client that the time spent in the MRI machine will only be 5 min:
This statement is misleading as MRI scans usually take longer than 5 minutes. Providing inaccurate information can undermine trust and increase anxiety if the procedure takes longer than stated.

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A nurse is assessing the health literacy of an older adult client who has type 2 diabetes mellitus. Which of the following actions should the nurse take?

Nursing Test Bank

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