A nurse is reviewing discharge instructions with a client who has Raynaud's disease. Which of the following client statements indicates an understanding of the teaching?
"I should not drive in the winter months."
"I am going to take a stress management class."
"I plan to use nicotine gum to help me quit smoking."
"I will limit myself to only two cups of coffee in the morning."
The Correct Answer is B
Choice A reason: Avoiding driving in winter is not necessary unless it is a personal trigger for Raynaud's attacks. It's more important to keep warm and manage stress.
Choice B reason: Stress management classes can teach techniques to control stress, which is beneficial for clients with Raynaud's disease as stress can trigger episodes.
Choice C reason: Using nicotine gum to quit smoking is a positive step for overall health, but it is not directly related to the management of Raynaud's disease.
Choice D reason: Limiting coffee intake may help some individuals with Raynaud's disease, as caffeine can constrict blood vessels, but it is not a universal recommendation.
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Related Questions
Correct Answer is C
Explanation
Choice A reason: Offering the bedpan every 2 hours is not specifically related to preventing urinary tract infections (UTIs) and may not be necessary unless the client has other needs that require frequent toileting.
Choice B reason: Cleansing the perineum from front to back is a standard practice to prevent the spread of bacteria from the anal area to the urethra, which can reduce the risk of UTIs.
Choice C reason: Encouraging fluid intake is crucial for clients with a spinal cord injury because it helps to flush out the urinary tract, preventing the buildup of bacteria that can cause UTIs.
Choice D reason: An indwelling urinary catheter may be necessary for a client with a T4 spinal cord injury who cannot effectively empty the bladder, but it should be used with caution as it can also increase the risk of UTIs. The decision to use an indwelling catheter should be based on a thorough assessment and consideration of all other options.
Correct Answer is A
Explanation
Choice A reason: Placing the client in a sitting position helps to lower blood pressure by promoting venous return and is the first action to take in cases of autonomic dysreflexia.
Choice B reason: Checking for a fecal impaction is important as it can be a trigger for autonomic dysreflexia, but it is not the first action to take.
Choice C reason: Examining for areas of skin breakdown is part of ongoing care for clients with spinal cord injuries but is not the immediate priority in autonomic dysreflexia.
Choice D reason: Checking blood pressure is important for monitoring the severity of autonomic dysreflexia, but the first action is to address the positioning of the client to manage the hypertensive crisis.
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