community health nurse is developing a plan of care for an older adult client who has type 2 diabetes mellitus and lives independently in a rural area. Which of the following interventions should the nurse include?

Suggest that the client attend adult day care three times per week.

Review assisted living accommodations with the client.

Discuss a long-term care referral for the client with the provider.

Instruct the client about the use of telehealth services.

Answer and Explanation

The Correct Answer is D

A. Suggest that the client attend adult day care three times per week: While adult day care can provide socialization opportunities and supervision for older adults, it may not be suitable for all clients, especially those who are still independent and prefer to live in their own homes. Additionally, attending adult day care may not directly address the client's diabetes management needs.
B. Review assisted living accommodations with the client: Assisted living accommodations are typically considered for individuals who require assistance with activities of daily living (ADLs) or who can no longer live independently. Since the client in this scenario lives independently, reviewing assisted living accommodations may not be appropriate at this time.
C. Discuss a long-term care referral for the client with the provider: Long-term care referrals are generally reserved for individuals who require ongoing assistance with ADLs and medical care that cannot be adequately provided in a home setting. Since the client is currently living independently and managing their diabetes, a long-term care referral may not be necessary.
D. Instruct the client about the use of telehealth services: This is the most appropriate intervention for the client in a rural area who may have limited access to healthcare resources. Telehealth services can provide remote monitoring, education, and support for managing diabetes while allowing the client to remain in their home environment. This intervention promotes independence and supports the client's ability to manage their condition effectively while living in a rural area.

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Correct Answer is B

Explanation

Answer: B. Turn on the faucets in the client's sink.

Rationale:

A. Tell the client to gently stroke their lower abdomen:
Stroking the abdomen may promote some sensory stimulation, but it is not a well-supported or commonly used intervention to stimulate voiding reflexes in clients having difficulty urinating on bed rest.

B. Turn on the faucets in the client's sink:
The sound of running water is a non-invasive, evidence-based method known to trigger the urge to urinate by stimulating the micturition reflex. This auditory cue can help relax pelvic muscles and facilitate urination, especially in clients struggling to void while in bed.

C. Pour cool water over the client's perineum:
Pouring cool water may not effectively stimulate urination and may cause discomfort. If water is used to promote voiding, it should be warm, not cool, to relax the perineal muscles and increase the likelihood of voiding.

D. Instruct the client to lean slightly backward:
Leaning backward can misalign the urethra and bladder, making voiding more difficult, especially for a female client in a supine or semi-recumbent position. A forward-leaning posture, if possible, is more anatomically favorable to aid urination.

A. Placental abruption B. Uterine rupture C. Placenta previa D. Amniotic fluid embolus

Correct Answer is A

Explanation

A. Placental abruption: Placental abruption is characterized by the premature separation of the placenta from the uterine wall before delivery of the fetus. Sudden, severe abdominal pain, moderate to severe vaginal bleeding, persistent uterine contractions, and uterine rigidity are classic signs and symptoms of placental abruption. Hypotension may occur due to hemorrhage, leading to decreased perfusion to vital organs.
B. Uterine rupture: Uterine rupture involves a tear in the uterine wall, which can lead to severe abdominal pain, vaginal bleeding, and signs of shock. However, uterine rupture typically occurs during labor or delivery, particularly in women with a history of uterine surgery or trauma.
C. Placenta previa: Placenta previa is characterized by the implantation of the placenta over or near the internal cervical os. It can cause painless vaginal bleeding in the third trimester, particularly after 20 weeks of gestation. However, it is not typically associated with severe abdominal pain or uterine rigidity.
D. Amniotic fluid embolus: An amniotic fluid embolus occurs when amniotic fluid, fetal cells, hair, or other debris enter the maternal circulation, leading to a potentially life-threatening reaction. Symptoms may include sudden dyspnea, hypotension, cardiovascular collapse, and disseminated intravascular coagulation (DIC). While it can cause severe complications, the symptoms described in the scenario are more consistent with placental abruption.

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community health nurse is developing a plan of care for an older adult client who has type 2 diabetes mellitus and lives independently in a rural area. Which of the following interventions should the nurse include?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a female client who requires bed rest and reports difficulty urinating into a bedpan. Which of the following actions should the nurse take?

Correct Answer is B

Explanation

Correct Answer is A

Explanation

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