Which nursing intervention is the most appropriate to implement for a client who experiencing weight loss due to nausea caused by chemotherapy?
Withhold solid foods and switch the client to liquid nutrition
Encourage the client to consume small, frequent meals throughout the day
Teach the client to eat one large meal per day to increase calorie intake
Insert a nasogastric tube and administer tube feedings
The Correct Answer is B
A. Automatically switching to liquid nutrition without assessing the client’s tolerance and needs may not be the most appropriate first step. It’s important to consider the client’s preferences, nutritional requirements, and overall ability to tolerate different types of food.
B. This is a highly appropriate and commonly recommended intervention for clients experiencing nausea and weight loss due to chemotherapy. Small, frequent meals can help manage nausea better than large meals and ensure a more consistent intake of calories and nutrients.
C. Eating one large meal per day is generally not advisable for clients with nausea, as it can exacerbate feelings of fullness and discomfort. Large meals may increase nausea and make it more difficult for the client to consume adequate nutrients. Small, frequent meals are generally better tolerated and more effective for managing nausea and ensuring consistent nutrient intake.
D. Inserting a nasogastric (NG) tube and administering tube feedings is a more invasive measure and is usually considered only if oral intake is severely compromised and other interventions have been ineffective. Tube feedings are appropriate for clients who cannot meet their nutritional needs through oral intake due to severe nausea, vomiting, or other conditions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Amlodipine is a calcium channel blocker used to manage hypertension. It is not associated with an increased risk of osteoarthritis. While hypertension itself is a health concern, amlodipine does not directly contribute to the development of OA.
B. Prednisone is a corticosteroid that can lead to various side effects, including bone loss and osteoporosis with long-term use. Although osteoporosis and OA are different conditions, long-term use of corticosteroids can potentially increase the risk of joint issues and contribute to the development or exacerbation of OA due to the impact on joint cartilage and bone density.
C. Warfarin is an anticoagulant used to prevent blood clots in atrial fibrillation. It is not directly associated with an increased risk of osteoarthritis. The primary concerns with warfarin involve bleeding risks rather than joint health.
D. Being Caucasian and having multiple children do not directly contribute to an increased risk of osteoarthritis.
Correct Answer is C
Explanation
A. Tachycardia (rapid heart rate) can occur in response to hypoxia (low oxygen levels), stress, or as a side effect of medications like albuterol. While tachycardia is a concerning sign in the context of an asthma exacerbation, it alone does not directly indicate the need for intubation and mechanical ventilation. It is often managed by addressing the underlying respiratory distress and improving oxygenation.
B. Anxiety is common in patients struggling to breathe, as they may feel frightened or panicked due to their difficulty breathing. However, anxiety itself is not an indicator for intubation and mechanical ventilation. It is a symptom of respiratory distress but does not directly assess the severity of the physiological need for mechanical support.
C. Hypotension (low blood pressure) in the context of an asthma exacerbation can be a sign of severe illness, possibly indicating shock or severe respiratory distress leading to reduced cardiac output. While hypotension is a serious concern, it is less directly related to the immediate need for intubation and mechanical ventilation compared to other indicators of respiratory failure.
D. Loud expiratory wheezing indicates significant airway obstruction but does not necessarily reflect the need for intubation and mechanical ventilation. Wheezing can be a sign of severe asthma but may not be sufficient on its own to necessitate intubation if the patient can still maintain adequate oxygenation and ventilation.
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