A nurse is teaching a client who has constipation. Which of the following should the nurse discuss as causes of constipation? (Select all that apply.)

Increased fiber in the diet

Ignoring the urge to defecate

Inadequate fluid intake

Increased activity

Excessive laxative use

Answer and Explanation

Correct Answer : B,C,E

A.   Increased fiber in the diet is not a cause of constipation, but rather a preventive measure that can help promote regular bowel movements by adding bulk and softness to the stool.
B.   Ignoring the urge to defecate is a cause of constipation, as it can lead to hardening and accumulation of fecal matter in the colon, resulting in difficulty and pain during defecation.
C.   Inadequate fluid intake is a cause of constipation, as it can contribute to dehydration and reduced stool moisture, making it harder and drier to pass.
D.   Increased activity is not a cause of constipation, but rather a beneficial factor that can stimulate intestinal motility and facilitate bowel elimination.
E.   Excessive laxative use is a cause of constipation, as it can interfere with the normal functioning of the colon and cause dependence, leading to decreased bowel tone and reduced peristalsis.

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Correct Answer is C

Explanation

A. Autonomy vs. shame and doubt focuses on developing a sense of independence and autonomy in early childhood (around 1-3 years old). It does not directly involve acceptance of death.
B. Identity vs. role diffusion pertains to adolescence (around 12-18 years old) and involves the development of a sense of self and one's role in society. It does not specifically address the acceptance of death.
C. Integrity vs. despair is the stage that occurs in late adulthood (65 years and older), where individuals reflect on their lives. Acceptance of death is a significant aspect of achieving a sense of integrity during this stage.
D. Generativity vs. stagnation occurs in adulthood (around 40-65 years old) and involves concerns about contributing to the next generation and leaving a legacy. While mortality may be a consideration, it is not the primary task of this stage.

A. Observe the client's respiratory status. B. Monitor intake and output every 8 hr. C. Elevate the head of the client's bed 30° to 45°. D. Check residual volume every 4 to 6 hr.

Correct Answer is C

Explanation

A. Observing the client's respiratory status is also important, but it is an ongoing assessment rather than an immediate action.

B. Monitoring intake and output every 8 hours is important for overall fluid balance, but it is not the top priority in this situation.

C. This is crucial to prevent aspiration, which can occur if the feeding formula enters the lungs, leading to pneumonia or other serious complications. Elevating the head of the bed helps keep the esophagus above the stomach, reducing the risk of aspiration.

D. Checking residual volume every 4 to 6 hours is a part of enteral feeding care, but it is not the top priority. Monitoring respiratory status takes precedence due to the potential risk of aspiration.

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A nurse is teaching a client who has constipation. Which of the following should the nurse discuss as causes of constipation? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for several clients who are at various developmental stages. The nurse should explain that, according to Erikson, acceptance of death is a primary task of which of the following stages of psychosocial development?

Correct Answer is C

Explanation

A nurse is planning care for a client who has a decreased level of consciousness. The client is receiving continuous enteral feedings via a gastrostomy tube due to an inability to swallow. Which of the following is the priority action by the nurse?

Correct Answer is C

Explanation

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