A nurse is reinforcing teaching about a safety plan for a client who reports partner violence. Which of the following instructions should the nurse include?

"Call a shelter in another county."

"Leave your partner immediately."

"Keep a packed bag by your front door."

"Rehearse your escape route."

Answer and Explanation

The Correct Answer is D

The nurse should include the instruction to "Rehearse your escape route" in the safety plan for a client who reports partner violence. A safety plan is a personalized and practical plan on how to remain safe in an abusive relationship while preparing to leave when the timing is right and safe to do so . Rehearsing an escape route can help the client be prepared and know what to do in case they need to leave quickly.

Option a is incorrect because calling a shelter in another county may not be the most practical or eﬀective option for the client.

Option b is incorrect because leaving an abusive partner immediately may not always be the safest option for the client.

Option c is incorrect because keeping a packed bag by the front door may not be the most practical or eﬀective option for the client.

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Correct Answer is B

Explanation

b. "You can use an adhesive remover when changing the colostomy skin barrier."

The nurse should inform the client that they can use an adhesive remover when changing the colostomy skin barrier. Adhesive removers are helpful in gently removing the adhesive residue left behind by the previous ostomy appliance. This can make the process of changing the colostomy skin barrier more comfortable for the client and help prevent skin irritation or damage.

Explanation for the other options:

a. "You should scrub the skin around the colostomy when cleaning." Scrubbing the skin around the colostomy can be harsh and may cause skin irritation or damage. It is recommended to clean the peristomal skin gently using mild soap and water, followed by thorough drying.

c. "You will need a device to suction stool from the colostomy bag." Suctioning stool from the colostomy bag is not a routine procedure for colostomy care. Colostomy bags are designed to collect stool, and emptying the bag as needed is the appropriate method of management.

d. "You should empty the colostomy bag when it is three-fourths full." The timing of emptying the colostomy bag may vary for each individual. It is generally recommended to empty the colostomy bag when it is one-third to one-half full to prevent leakage or discomfort. The client should be educated on monitoring the bag and emptying it as necessary based on their own output and comfort level.

A. Consume more prepared frozen dinners to minimize cooking with salt. B. Add salt when preparing a meal instead of at the table. C. Use imitation crab and lobster products for salads at home. D. Replace bottled salad dressing with homemade vinegar and oil dressing.

Correct Answer is D

Explanation

A client with heart failure should limit their sodium intake. Bottled salad dressings can be high in sodium, so replacing them with homemade vinegar and oil dressing can help reduce sodium intake.

The other options are not recommended for a client with heart failure who needs to limit their sodium intake.

a) Prepared frozen dinners are often high in sodium.

b) Adding salt when preparing a meal would increase sodium intake.

c) Imitation crab and lobster products (option can also be high in sodium.

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A nurse is reinforcing teaching about a safety plan for a client who reports partner violence. Which of the following instructions should the nurse include?

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Naxlex Comprehensive Predictor Exams

A nurse is reinforcing teaching with a client about caring for a new colostomy. Which of the following statements should the nurse make?

Correct Answer is B

Explanation

A nurse is caring for a client who has heart failure and reports difficulty with limiting sodium in their diet. Which of the following recommendations should the nurse provide?

Correct Answer is D

Explanation

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