A nurse is preparing to teach the parents of a child who has cystic fibrosis. Which of the following instructions should the nurse plan to include?

Trim the fat from red meat prior to cooking.

Give the child hot foods to reduce the sense of fullness.

Administer pancreatic enzymes 30 min after meals.

Provide a diet high in protein and calories.

Answer and Explanation

The Correct Answer is D

A. Trim the fat from red meat prior to cooking: Children with cystic fibrosis (CF) require a high-calorie, high-fat diet due to malabsorption from pancreatic insufficiency. Trimming fat would reduce caloric intake and fat-soluble vitamin absorption, which is contraindicated in CF nutritional management.

B. Give the child hot foods to reduce the sense of fullness: Food temperature does not significantly affect satiety or nutrient absorption in CF. The focus should be on calorie density and nutrient content rather than temperature, as energy needs are significantly increased in these children.

C. Administer pancreatic enzymes 30 min after meals: Pancreatic enzyme replacement therapy should be given with meals or immediately before eating to optimize digestion of fats, proteins, and carbohydrates. Administering enzymes after meals would reduce nutrient absorption and worsen malnutrition.

D. Provide a diet high in protein and calories: Children with CF have increased metabolic demands and impaired nutrient absorption, making a high-calorie, high-protein diet essential to support growth, maintain weight, and compensate for malabsorption.

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Correct Answer is ["A","D","E","F","H"]

Explanation

A. Weight assessment: The client gained 0.68 kg (1.5 lb) in one week, which may indicate rapid fluid retention. In the context of hypertension and edema, this requires follow-up for possible preeclampsia or fluid overload.

B. Respiratory assessment: Respirations are even, non-labored, and oxygen saturation is 95%, which is within acceptable limits for 30 weeks of gestation. No immediate follow-up is indicated based solely on these findings.

C. Fundal height: The fundal height is 29 cm at 30 weeks gestation, 29 cm at 30 weeks is within the expected range (usually +/- 2 cm of the week of gestation).

D. Lower extremity assessment: The client has 1+ dependent edema bilaterally. Combined with hypertension and facial edema, this finding may indicate fluid retention associated with preeclampsia, requiring monitoring and further evaluation.

E. Blood pressure: The client’s blood pressure is 148/94 mm Hg, which is elevated for pregnancy. Hypertension at 30 weeks can indicate preeclampsia and requires prompt assessment and intervention.

F. Nausea: While common in early pregnancy, nausea and vomiting in the third trimester—especially when paired with right upper abdominal pain—suggest liver involvement or Glisson's capsule stretching, which are "severe features" of preeclampsia/HELLP syndrome.

G. Fetal heart tracing: Fetal heart rate is 140/min with no contractions, which is within normal limits for gestation. No immediate follow-up is necessary based on this assessment.

H. DTR: Deep tendon reflexes are 3+ bilaterally, indicating hyperreflexia. This is a concerning sign for preeclampsia and requires prompt follow-up to prevent complications such as seizures.

A. Limit the client's opportunities to socialize with others. B. Speak in a neutral tone when addressing the client. C. Mix the medication with the client's food items. D. Rotate staff members caring for the client.

Correct Answer is B

Explanation

A. Limit the client's opportunities to socialize with others: Social isolation can worsen paranoia and reinforce distrust. Encouraging safe, structured interactions is more therapeutic than limiting socialization.

B. Speak in a neutral tone when addressing the client: A neutral, calm, and nonjudgmental tone helps build trust and reduces the likelihood of misinterpretation of the nurse’s intent, which is critical for clients with paranoid personality disorder who are sensitive to perceived threats or hostility.

C. Mix the medication with the client's food items: Covertly administering medication violates client autonomy and can exacerbate distrust. Clients with paranoid personality disorder are likely to detect such actions, worsening their paranoia and potentially creating legal and ethical issues.

D. Rotate staff members caring for the client: Frequent rotation of staff can undermine trust and reinforce paranoia, as the client may perceive inconsistency as a threat. Consistency in caregivers helps establish therapeutic rapport and promotes adherence to treatment plans.

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A nurse is preparing to teach the parents of a child who has cystic fibrosis. Which of the following instructions should the nurse plan to include?

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