Exhibits
Which interventions are indicated to promote positive outcomes for the client? Select all that apply.
Acknowledge feelings of anxiety.
Weigh the client twice weekly.
Encourage exercise.
Provide family education on the condition.
Monitor trips to the restroom.
Allow for menu deviations.
Set precise mealtimes.
Correct Answer : A,B,D,E,G
A. Acknowledge feelings of anxiety: The client's neurological assessment indicates agitation, and acknowledging this can help in addressing any underlying anxiety.
B. Weigh the client twice weekly: Given the client's low BMI and the mother's concern about her weight, regular monitoring is necessary.
C. Encourage exercise: While exercise is generally healthy, the client's current bradycardia and low BMI suggest that immediate physical exertion may not be advisable without medical
supervision.
D. Provide family education on the condition: The client's mother's concern and the client's defensiveness about her weight indicate a need for family education.
E. Monitor trips to the restroom: Monitoring is important to ensure the client is not engaging in behaviors that could further compromise her health, such as purging.
F. Allow for menu deviations is incorrect. Allowing menu deviations can enable the client to avoid certain foods, which reinforces disordered eating behaviors. Structured, balanced meals are essential for recovery.
G. Set precise mealtimes is correct because establishing structured mealtimes promotes consistency and reduces anxiety related to eating. This helps the client develop healthier eating patterns and decreases the urge to binge or purge.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Determine if the newborn is in the nursery: This action directly addresses the immediate concern of the missing newborn and ensures prompt verification of the infant's location.
B. Match ID bands of all infants and mothers on the unit: While important for ensuring proper
identification, this action may take longer to complete and should follow the immediate concern of locating the newborn.
C. Activate the lockdown procedure: This extreme measure should only be implemented if there is evidence of a security threat or if there is reason to believe that the newborn has been
abducted.
D. Ask the mother if any visitors were expected to arrive: While obtaining this information may be relevant for investigation purposes, it should not delay the immediate search for the newborn.
Correct Answer is D
Explanation
A. Administering aspirin may be appropriate for suspected ischemic stroke; however, it should not be done without confirmation of diagnosis and evaluation by the stroke team.
B. Initiating pneumatic compression devices is not the priority in this situation. Acute assessment and management of the suspected stroke take precedence.
C. Placing an indwelling urinary catheter and measuring strict intake and output may be necessary for ongoing care but is not the priority when the client is presenting with symptoms suggestive of a stroke.
D. Notifying the stroke team to assist with acute assessment and management is the priority intervention. Time is crucial in the management of stroke, and early intervention can help minimize neurological damage and improve outcomes.
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