A nurse is providing follow-up care with a client who participated in a class about improving bone health. Which of the following client statements should the nurse identify as an understanding of the teaching?
"I have been taking 500 micrograms per day of vitamin A supplement."
"I take an 800-milligram calcium supplement with my breakfast every day."
"I have included fortified milk, fatty fish, and cheese into my diet each day."
"I increased my intake of orange juice, lean meats, and egg whites."
The Correct Answer is C
Choice C reason: This statement shows that the client has understood the importance of vitamin D and calcium for bone health. Fortified milk, fatty fish, and cheese are good sources of both nutrients, which help to maintain bone density and prevent osteoporosis.
Choice A reason: This statement is incorrect, as vitamin A supplementation can have adverse effects on bone health. Excessive intake of vitamin A can increase the risk of fractures and reduce bone mineral density.
Choice B reason: This statement is partially correct, as calcium supplementation can help to meet the daily requirement of calcium for bone health. However, calcium alone is not enough, as vitamin D is also needed to facilitate the absorption of calcium and prevent its loss from the bones.
Choice D reason: This statement is irrelevant, as none of the foods mentioned are particularly beneficial for bone health. Orange juice, lean meats, and egg whites are good sources of vitamin C, protein, and biotin, respectively, but they do not provide significant amounts of vitamin D or calcium.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason:A firm bilateral hand grip indicates normal muscle strength, which is a positive sign but not directly related to hypernatremia treatment efficacy.
Choice B reason: Fatigue is not a sign of effective treatment for hypernatremia. Fatigue can be a symptom of hypernatremia, as well as dehydration, infection, or other conditions. The nurse should assess the client for other causes of fatigue and monitor their vital signs and fluid status.
Choice C reason:Deep tendon reflexes graded as 2+ are considered normal and suggest that neuromuscular function is intact. Since hypernatremia can cause neuromuscular excitability, normal reflexes may indicate effective treatment.
Choice D reason: Urine output 25 mL/hr is not a sign of effective treatment for hypernatremia. Urine output 25 mL/hr is below the normal range of 30 to 50 mL/hr and indicates oliguria, which can be a complication of hypernatremia. Oliguria can result from dehydration, kidney damage, or reduced blood flow to the kidneys due to hypernatremia. The nurse should notify the provider and administer fluids as prescribed.
Correct Answer is B
Explanation
Choice A reason: Measuring the client's gastric residual every 12 hr is not frequent enough to monitor the feeding tolerance and prevent aspiration. The nurse should measure the gastric residual before each intermittent feeding or every 4 to 6 hr during continuous feeding¹².
Choice B reason: Flushing the client's tube with 30 mL of water every 4 hr is an appropriate action to maintain the tube patency, prevent clogging, and hydrate the client. The nurse should flush the tube before and after each medication administration, feeding, or gastric residual check¹³.
Choice C reason: Keeping the client's head elevated at 15° during feedings is not sufficient to prevent reflux and aspiration. The nurse should elevate the head of the bed at least 30° to 45° during feedings and for at least 30 min to 1 hr after feedings¹⁴.
Choice D reason: Obtaining the client's electrolyte levels every 4 hr is not necessary unless the client has signs of fluid or electrolyte imbalance, such as edema, dehydration, or abnormal vital signs. The nurse should monitor the client's weight, intake and output, and laboratory values as ordered by the provider¹⁵.
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