The nurse is reviewing risk factors for cholelithiasis in a client’s history. Which factor most significantly increases the client’s risk for developing gallstones?

Choice A reason: Gluten avoidance is specific to celiac disease, not Crohn’s, which involves autoimmune inflammation of the gut. Crohn’s dietary triggers vary individually, and gluten is not a universal issue. An elimination diet identifies specific triggers, making this response incorrect for Crohn’s management.

Choice B reason: Fluid restriction is not a primary limitation in Crohn’s disease, which often requires adequate hydration due to diarrhea. Restricting fluids could worsen dehydration. An elimination diet to identify trigger foods is more appropriate, as dietary management focuses on individual sensitivities, not fluid limits.

Choice C reason: An elimination diet identifies trigger foods causing Crohn’s flare-ups, as sensitivities vary. By systematically removing and reintroducing foods, patients pinpoint irritants like dairy or fiber, personalizing dietary management. This is the most effective approach, as Crohn’s lacks universal dietary restrictions, making it the correct response.

Choice D reason: Limiting calcium and iron is not standard for Crohn’s, as these nutrients are often deficient due to malabsorption. Supplementation may be needed. An elimination diet better addresses symptom triggers, as nutrient restriction could exacerbate deficiencies without targeting inflammatory food triggers.

Choice A reason: Using a bronchodilator for sudden shortness of breath applies to rescue inhalers like albuterol, not maintenance bronchodilators (e.g., tiotropium) for COPD, which are used daily. This statement indicates misunderstanding, as maintenance inhalers prevent symptoms, not treat acute dyspnea.

Choice B reason: Thinner sputum is not a primary effect of bronchodilators, which relax airway smooth muscles to improve airflow in COPD. Mucolytics, not bronchodilators, reduce sputum viscosity. This statement reflects incorrect understanding, as bronchodilators target bronchoconstriction, not secretion consistency.

Choice C reason: Daily use of a maintenance bronchodilator, like tiotropium, is correct for COPD to prevent bronchospasm and maintain airway patency. This statement shows proper understanding, as consistent use reduces exacerbations and improves lung function, aligning with standard COPD management protocols.

Choice D reason: Using another inhaler between doses suggests confusion about maintenance versus rescue inhalers. Maintenance bronchodilators are used daily, not interspersed with others. This indicates misunderstanding, as proper scheduling is essential for effective COPD control with prescribed bronchodilators.