The nurse is developing a plan of care for a client who reports frequent urination and who is newly diagnosed with type 2 diabetes. Which outcome should the nurse include in the plan of care for this client?

The client will express acceptance of their newly diagnosed health status.

The client's haemoglobin A1C will be less than 7.0% in 3 months.

The client's family will state signs and symptoms about the disease.

The nurse will monitor the client's skin condition for colour changes.

Answer and Explanation

The Correct Answer is B

Choice A reason: While it is important for the client to accept their new health status, this outcome is subjective and difficult to measure. The focus should be on specific, measurable outcomes related to diabetes management.

Choice B reason: A haemoglobin A1C level of less than 7.0% in 3 months is a specific, measurable outcome that indicates good control of blood glucose levels. It reflects adherence to the prescribed diabetic regimen and effective management of the condition.

Choice C reason: Educating the client's family about the signs and symptoms of diabetes is important, but it is more of a teaching objective rather than a measurable outcome for the client's plan of care.

Choice D reason: Monitoring the client's skin condition for colour changes is part of routine care but does not directly address the management of diabetes or measure the effectiveness of the treatment plan.

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Correct Answer is C

Explanation

Choice A reason: Keeping toenails trimmed short is important for foot care, especially in clients with PAD, but it is not the highest priority.

Choice B reason: Applying a heating pad to soothe leg pain can provide temporary relief but does not address the underlying issue of PAD or reduce cardiovascular risk.

Choice C reason: Enrolling in a smoking cessation program is the highest priority. Smoking significantly exacerbates PAD and increases the risk of further cardiovascular events, including heart attacks. Quitting smoking is crucial for improving vascular health and reducing the risk of complications.

Choice D reason: Reducing intake of high saturated fats and salt is important for overall cardiovascular health but is not as immediate or impactful as smoking cessation in reducing the risk of complications from PAD and MI.

A. Degree of skin elasticity. B. Length of capillary refill. C. Rhythm of apical pulse. D. Volume of pedal pulses.

Correct Answer is C

Explanation

Choice A reason: The degree of skin elasticity is a measure often used to assess hydration status, especially in older adults. However, it does not provide direct information about the client's cardiac function or the cause of their current symptoms.

Choice B reason: The length of capillary refill is useful for assessing peripheral perfusion and overall circulatory status. While prolonged capillary refill can indicate poor perfusion, it does not provide specific information about heart rhythm or the cause of palpitations and faintness in a client with heart failure.

Choice C reason: The rhythm of the apical pulse is the most important assessment data to obtain in this scenario. The client's complaint of a fast-beating heart and feeling faint suggests a possible arrhythmia, which could be detected by assessing the rhythm of the apical pulse. This assessment can help identify irregular heartbeats, tachycardia, or other abnormalities that may require immediate intervention.

Choice D reason: The volume of pedal pulses can provide information about peripheral circulation, but it is not as crucial as assessing the heart rhythm in a client experiencing palpitations and faintness. Peripheral pulse volume may not change significantly with certain arrhythmias or cardiac issues that affect the central circulation more directly.

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The nurse is developing a plan of care for a client who reports frequent urination and who is newly diagnosed with type 2 diabetes. Which outcome should the nurse include in the plan of care for this client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is developing a teaching plan for a client with peripheral arterial disease (PAD) who has a history of a myocardial infarction (MI) and smokes two packs of cigarettes daily. Which instruction has the greatest priority?

Correct Answer is C

Explanation

A client with heart failure (HF) is waiting in the preoperative area for a scheduled procedure and tells the nurse, "My heart feels like it is beating too fast and I feel faint." After initiating a call for an electrocardiogram (ECG), which assessment data is most important for the nurse to obtain?

Correct Answer is C

Explanation

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