A nurse is caring for a client who underwent an appendectomy 2 days ago and now reports sudden, unbearable pain in the left great toe. The client has a medical history of type 2 diabetes mellitus, gouty arthritis, and gastroesophageal reflux disease (GERD). Which instruction should the nurse include in the discharge teaching?

Eat high-protein foods to achieve ideal body weight.

Avoid acetylsalicylic acid-containing medications.

Wrap joints with an elastic bandage when swollen.

Support joints in an extended position while resting.

Answer and Explanation

The Correct Answer is B

Choice A reason: Eating high-protein foods to achieve ideal body weight is generally a healthy practice, but it is not directly related to the management of the client's current condition involving pain in the toe.

Choice B reason: Patients with gouty arthritis should avoid acetylsalicylic acid (aspirin) as it can lead to an increase in uric acid levels, potentially exacerbating gout attacks. Instead, medications that do not affect uric acid levels should be used for pain relief.

Choice C reason: Wrapping joints with an elastic bandage can provide support and reduce swelling, but it is not the primary intervention for sudden pain in the toe following an appendectomy, especially when the patient has a history of gouty arthritis.

Choice D reason: Supporting joints in an extended position while resting can provide comfort and may prevent stiffness, but it does not address the acute management of gouty arthritis or diabetic complications that could be causing toe pain.

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Correct Answer is ["A","B","D","E","G"]

Explanation

Choice A reason: Learned coping skills are essential for managing the psychological aspects of obesity and the lifestyle changes required after bariatric surgery. The patient’s engagement with a psychologist and learning coping techniques can help her deal with postoperative stress and maintain the lifestyle modifications necessary for long-term success.
Choice B reason: A psychological assessment helps in understanding the patient’s readiness for surgery and ability to adhere to the postoperative regimen. It can identify any psychological barriers to weight loss and ensure that the patient is mentally prepared for the changes ahead.
Choice C reason: The term “unstained weight loss” seems to be a typographical error, possibly intending to mean “sustained weight loss.” However, sustained weight loss is not applicable in this context as the patient has not yet undergone surgery. Therefore, it does not contribute to the chances of positive outcomes post-surgery.
Choice D reason: Recovery close to the hospital can be beneficial as it allows for easier follow-up visits and quicker access to medical care if complications arise. It also reduces the stress associated with travel for postoperative care.
Choice E reason: Recent weight loss prior to surgery is a positive indicator as it shows the patient’s commitment to lifestyle changes and weight management. It can also reduce surgical risk and improve postoperative recovery1.
Choice F reason: While age can be a factor in surgical risk, there is no direct correlation between the client’s age and the chance for positive outcomes after bariatric surgery. Therefore, it is not a contributing factor in this scenario.
Choice G reason: Family support is crucial for a patient’s recovery and long-term success after bariatric surgery. The patient’s plan to go home with her mother, who lives close to the hospital, indicates a strong support system which can help with adherence to dietary and lifestyle changes.
Choice H reason: A high BMI, such as 41.4 kg/m^2, indicates severe obesity, which is the reason for undergoing bariatric surgery. While it is a factor for considering surgery, it does not inherently increase the chance for positive outcomes post-surgery.

A. Avoiding the use of sunscreen is important for adequate vitamin D synthesis. B. Vitamin D combined with calcium is balanced with phosphorus for absorption for strong bones. C. Calcium uses vitamin D that is produced in the skin by exposure to sunshine. D. Adding daily Vitamin D with oral calcium supplements promotes absorption of calcium into bone.

Correct Answer is D

Explanation

Choice A reason: Avoiding sunscreen is not recommended as it increases the risk of skin cancer; vitamin D can be obtained safely through diet and supplements.

Choice B reason: While it is true that vitamin D and calcium are balanced with phosphorus, this statement does not directly encourage compliance with supplementation.

Choice C reason: Although calcium uses vitamin D produced by sunlight exposure, relying solely on sunshine is not sufficient, especially for individuals at risk of osteoporosis.

Choice D reason: Emphasizing that vitamin D enhances calcium absorption into the bone provides a clear rationale for the client to comply with the supplementation regimen.

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Naxlex Comprehensive Predictor Exams

Patient Data Exhibits The nurse reviews the client data. What increases the client's chance for positive outcomes after the completion of the bariatric surgery? Select all that apply.

Correct Answer is ["A","B","D","E","G"]

Explanation

The nurse is teaching a client with early osteoporosis the importance of including vitamin D with calcium supplements. Which information is most important for the nurse to provide to encourage the client's compliance in the management of progressing osteoporosis?

Correct Answer is D

Explanation

The nurse manager is involved in agency restructuring. During this reengineering process, it is most important for the nurse to address which employee concern?

The hospice nurse is teaching the family of a client receiving palliative care at home how to provide care. Which instruction should the nurse provide?

A 22-year-old client is admitted to the hospital in diabetic ketoacidosis (DKA). The client's parent is insisting on knowing the laboratory test results. Which is the best response for the nurse to provide?

Patient Data Exhibits The nurse reviews the post catheterization orders. Which two orders would the nurse question?

A nurse observes a practical nurse (PN) pouring warm water over the perineal area of a female client who has frequent urinary incontinence while the client is positioned on a bedpan. Which action should the nurse take?

One hour following cardiac catheterization via the left femoral site, a client reports feeling weak and dizzy. Assessment reveals that the client's dressing is dry and intact. Which action should the nurse take next?

A parent asks the nurse how to care for their 4-year-old child after receiving the Haemophilus influenzae type b (Hib) conjugate vaccine. Which instruction should the nurse provide?