A nurse is contributing to the plan of care for a client who has labyrinthitis. Which of the following interventions should the nurse include in the plan?

Limit fluid intake.

Monitor client’s cardinal fields of vision.

Encourage ambulation.

Ensure the room is brightly lit.

Answer and Explanation

The Correct Answer is B

Choice A reason: Limiting fluid intake is not an appropriate intervention for labyrinthitis. Adequate hydration is important for overall health and should be maintained.

Choice B reason: The correct answer is b because labyrinthitis can affect the vestibular system, leading to dizziness and vertigo. Monitoring the client’s cardinal fields of vision helps assess for nystagmus, which is a common symptom of vestibular disorders.

Choice C reason: Encouraging ambulation is not advisable for clients with labyrinthitis, as it can increase the risk of falls and injury due to dizziness and imbalance.

Choice D reason: Ensuring the room is brightly lit is not necessary for the management of labyrinthitis and may not provide any therapeutic benefit.

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Correct Answer is B

Explanation

Choice A reason: While bulimia can cause gastrointestinal issues, it is not directly linked to the development of peptic ulcers. Peptic ulcers are primarily associated with factors that affect the stomach lining and increase gastric acidity.

Choice B reason: The correct answer is b because the use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen is a well-known risk factor for peptic ulcers. NSAIDs can irritate the stomach lining and inhibit the production of protective mucus, leading to ulcer formation.

Choice C reason: Drinking green tea has not been shown to be a risk factor for peptic ulcers. In fact, some studies suggest that green tea may have protective effects on the stomach lining.

Choice D reason: Consuming spicy foods is often believed to cause peptic ulcers, but there is no scientific evidence to support this. Spicy foods may exacerbate symptoms in individuals with existing ulcers, but they do not cause the condition.

A. Refusing to look at the dressing or surgical incision. B. Requesting pain medication every 3 hr. C. Asking questions about the information on the postoperative care pamphlet. D. Performing arm exercises once or twice each day.

Correct Answer is A

Explanation

Choice A reason: The correct answer is a because refusing to look at the dressing or surgical incision can indicate that the client is having difficulty accepting the loss of her breast. This behavior may suggest that the client is struggling with body image issues, grief, or denial about the changes to her body.

Choice B reason: Requesting pain medication every 3 hours is a common postoperative behavior to manage pain and does not necessarily indicate difficulty adjusting to the loss of a breast. Pain management is a normal part of recovery.

Choice C reason: Asking questions about the information on the postoperative care pamphlet demonstrates an interest in understanding and managing her care. This behavior indicates that the client is engaged in her recovery process, rather than struggling to adjust.

Choice D reason: Performing arm exercises once or twice each day shows that the client is following postoperative care instructions and is actively participating in her rehabilitation. This behavior does not suggest difficulty adjusting to the loss of her breast.

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A nurse is contributing to the plan of care for a client who has labyrinthitis. Which of the following interventions should the nurse include in the plan?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reviewing the medical record of a client who has a peptic ulcer. Which of the following findings should the nurse identify as a risk factor for this condition?

Correct Answer is B

Explanation

A nurse is caring for a client who is 1 day postoperative following a left radical mastectomy. Which of the following client behaviors should alert the nurse that the client is having difficulty adjusting to the loss of her breast?

Correct Answer is A

Explanation

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