A patient at a long-term care facility makes the following statements regarding management of his constipation. Which statement would require follow-up teaching by the nurse?
I try to walk in the hallway each day with assistance.
I need to increase fiber in my diet and drink more water.
I take my laxative every morning and an enema every night.
The pain medication I take tends to make my constipation worse.
The Correct Answer is C
Choice A reason: I try to walk in the hallway each day with assistance is a correct statement. Walking is a form of physical activity that can stimulate bowel movements and prevent constipation. Walking also has other benefits such as improving circulation, muscle strength, and mood. The patient should be encouraged to walk as much as possible with assistance to prevent falls and injuries.
Choice B reason: I need to increase fiber in my diet and drink more water is a correct statement. Fiber is a type of carbohydrate that is not digested by the body and helps to form soft and bulky stools. Fiber can be found in foods such as fruits, vegetables, whole grains, nuts, and seeds. Water is essential for hydration and helps to soften the stools and ease their passage. The patient should be advised to consume at least 25 grams of fiber and 8 glasses of water per day to prevent constipation.
Choice C reason: I take my laxative every morning and an enema every night is an incorrect statement that requires follow-up teaching by the nurse. Laxatives and enemas are medications that are used to treat constipation by stimulating or lubricating the bowel. However, they should not be used routinely or excessively, as they can cause side effects such as dehydration, electrolyte imbalance, abdominal cramps, diarrhea, or dependence. The patient should be instructed to use laxatives and enemas only as prescribed by the doctor and for a short period of time. The patient should also be informed of the potential risks and complications of overusing laxatives and enemas.
Choice D reason: The pain medication I take tends to make my constipation worse is a correct statement. Pain medications, especially opioids, can slow down the movement of the bowel and cause constipation. This is a common and expected side effect of pain medications. The patient should be educated on how to manage constipation caused by pain medications, such as increasing fiber and water intake, exercising regularly, and using stool softeners or laxatives as needed. The patient should also be reassured that constipation does not mean that the pain medication is not working or that they are addicted to it.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Utilize supine positioning to maximize chest expansion is not an important intervention for clients with a BMI greater than or equal to 30. Supine positioning is when the client lies flat on their back. This position can actually impair chest expansion and breathing for clients with a high BMI, as the weight of the abdomen and chest can compress the lungs and diaphragm. A semi-Fowler's position, where the head of the bed is elevated at 30 to 45 degrees, is preferred for these clients, as it reduces the pressure on the chest and improves ventilation.
Choice B reason: Use an appropriately sized blood pressure cuff is an important intervention for clients with a BMI greater than or equal to 30. A blood pressure cuff that is too small or too tight can cause inaccurate readings and increase the risk of injury to the client. A blood pressure cuff that is too large or too loose can also cause inaccurate readings and compromise the quality of care. A blood pressure cuff that fits the client's arm circumference and width is essential for obtaining accurate and reliable measurements and preventing complications.
Choice C reason: Consult a nutritionist because the client is malnourished/underweight is not an important intervention for clients with a BMI greater than or equal to 30. A BMI greater than or equal to 30 indicates that the client is obese, not malnourished or underweight. Obesity is a condition where the client has excess body fat that can affect their health and well-being. Malnutrition is a condition where the client has inadequate or imbalanced intake of nutrients that can affect their growth and development. Underweight is a condition where the client has a low body weight that can affect their immunity and energy. A nutritionist can help clients with any of these conditions, but the statement is incorrect for clients with a high BMI.
Choice D reason: Place the client on fall precautions because of increased risk for falls due to frail bones is not an important intervention for clients with a BMI greater than or equal to 30. Frail bones are not a common consequence of obesity, but rather of osteoporosis, a condition where the bones become weak and brittle. Obesity can actually increase the bone density and strength, as the bones have to support more weight. However, obesity can increase the risk for falls due to other factors, such as impaired mobility, balance, or coordination. Fall precautions are important for any client who is at risk for falls, but the statement is inaccurate for clients with a high BMI.
Correct Answer is B
Explanation
Choice A reason: Environmental stress is not the correct answer. Environmental stress is caused by external factors that are beyond the person's control, such as noise, pollution, weather, or natural disasters. These factors can affect the person's physical and mental health, but they are not related to the person's specific situation or event.
Choice B reason: Situational stress is the correct answer. Situational stress is caused by a particular situation or event that the person faces, such as a test, a job interview, a conflict, or a loss. These situations or events can create pressure, uncertainty, or anxiety for the person, and they may require the person to adapt or cope with the change or challenge.
Choice C reason: Daily Hassle stress is not the correct answer. Daily Hassle stress is caused by the minor annoyances or frustrations that the person encounters in their everyday life, such as traffic, deadlines, bills, or household chores. These hassles can accumulate and affect the person's mood, health, or well-being, but they are not related to the person's specific situation or event.
Choice D reason: Episodic stress is not the correct answer. Episodic stress is caused by frequent or chronic exposure to stressful situations or events, such as work overload, financial problems, or family issues. These situations or events can create a constant state of worry, agitation, or distress for the person, and they may affect the person's physical and mental health. Episodic stress is not a type of stress, but rather a result of experiencing too much stress over a long period of time.
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