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Improving stress management skills might be beneficial for overall well-being, but it's not the primary goal in managing degenerative joint disease (DJD. Stress management could be asecondary intervention to support pain management, but it's not the primary goal.

While reducing the risk for infection is important in nursing care, it's not the primary goal specifically related to degenerative joint disease (DJD. Infection prevention measures areimportant for overall health but aren't directly addressing the primary concern of pain management.

Obtaining adequate rest and sleep is important for overall health, but it's not the primary goal when planning nursing care for a client with degenerative joint disease (DJD. Pain controltypically takes precedence in the care plan because pain can significantly impact rest and sleep.

Observing body language and movement can provide valuable information about pain, but it doesn't directly assess the quality of the pain. It's more indicative of the client's physical response to pain rather than the pain itself.

Identifying effective pain relief measures is important for pain management but doesn't directly assess the quality of the pain. This approach focuses on interventions rather than understanding the nature of the pain.

Providing a numeric pain scale can quantify the intensity of pain, but it doesn't necessarily assess the quality of the pain. While useful for tracking pain levels over time, it doesn't provide insights into the characteristics or nature of the pain.

Administering the placebo as prescribed when the client reports pain is ethically questionable.Placebos are typically used in research or clinical trials and should not be administered without the client's informed consent and understanding.

While informing the charge nurse about the prescribed placebo is appropriate, refusing to administer it without further action may not address the ethical concerns surrounding placebo use.

Informing the client that the provider prescribed a placebo instead of pain medication is important for transparency and informed consent. However, this should be accompanied by discussing the ethical considerations with the healthcare provider.

Providing protective undergarments may be necessary as a temporary measure to manage urinary incontinence, but it does not address the underlying cause. It should not be the initial intervention.

Encouraging increased fluid intake may exacerbate urinary incontinence if the cause is related to an overactive bladder or other urinary tract issues. It's important to determine the cause before recommending changes in fluid intake.

Evaluating the client's response to bladder training efforts is a relevant intervention for urinary incontinence, but it assumes that bladder training is appropriate for the client's condition. Before initiating bladder training, it's essential to assess the client's condition through proper evaluation.

Reinforcing bed rest until the analgesic is effective may not address the client's need to sit up and lean forward. It's important to respond to the client's discomfort and find a position thatprovides relief.

Placing the bed in reverse Trendelenburg position (head elevated, feet lowered) may not be the most effective position for a client experiencing severe epigastric pain and nausea. Thisposition could potentially worsen symptoms or discomfort.

Raising the head of the bed to a 90-degree angle may not provide optimal relief for the client.While it's essential to elevate the head of the bed for comfort and to prevent aspiration, it may not address the client's specific need to lean forward.

Elevating the head of the bed to a 45-degree angle is important for clients with obstructive sleep apnea (OSA to help prevent airway obstruction during sleep. However, applying thepositive airway pressure device is a more immediate and direct intervention to ensure adequate breathing.

Removing dentures or other oral appliances may be necessary for comfort and safety during sleep, but it's not directly related to managing obstructive sleep apnea in this scenario.

Lifting and locking the side rails in place is a standard safety measure in healthcare settings but does not address the client's obstructive sleep apnea or ensure adequate ventilation.

Asking the client how often episodes of sundowning are experienced is not relevant to afunctional assessment. Sundowning refers to increased confusion and agitation that typically occurs in the late afternoon or evening and is often associated with dementia.

Encouraging the client to lie as still as possible during the assessment may not provide accurate information about the client's functional status. It's important for the client to engage in activities that reflect their typical level of functioning.

Assisting the client with values clarification about end-of-life care options is important but not typically part of a functional assessment focused on evaluating the client's physical and cognitive abilities.

Asking the client how often episodes of sundowning are experienced is not relevant to a functional assessment. Sundowning refers to increased confusion and agitation that typically occurs in the late afternoon or evening and is often associated with dementia.

Assisting the client with values clarification about end-of-life care options is important but not typically part of a functional assessment focused on evaluating the client's physical and cognitive abilities.

Encouraging the client to lie as still as possible during the assessment may not provide accurate information about the client's functional status. It's important for the client to engage in activities that reflect their typical level of functioning.

Assessing the magnesium level is important in some cases, especially since electrolyte imbalances can occur in diabetic ketoacidosis (DKA. However, in this scenario, the most critical assessment relates to the management of hyperglycemia and the potential for hypoglycemia during treatment.

Ensuring an appropriate size of the IV catheter is essential for delivering IV fluids and medications effectively, but it is not the most crucial assessment in this situation.

Although glucose levels are monitored closely in DKA, they are not the primary concern before administering potassium chloride. The priority here is ensuring the kidneys can excrete potassium effectively, as hyperkalemia can be life-threatening.

Administering the drops with the head held upright may be necessary for some ear drop medications, but it is not the most appropriate technique for all types of ear drops.

Cooling and shaking the bottle before administering the drops may be necessary for certain types of medications but is not universally recommended for all ear drop preparations.

Inserting the tip of the dropper into the canal of the ear is appropriate for administering ear drops, but it should be accompanied by the correct technique of pulling the pinnae up and back to straighten the ear canal in adults.

Noting areas of atelectasis on daily chest x-rays is important for assessing respiratory status, but it is a monitoring intervention rather than a preventive intervention.

Assisting the client to a chair the day after surgery when the condition is stable promotes early mobility and prevents complications such as deep vein thrombosis, but it may not directlyaddress respiratory complications.

Providing ice or oral liquids when the client passes flatus may be part of the postoperative care plan, but it does not directly address respiratory complications. It's more related to bowel function and hydration status.

Connecting the nasogastric tube to high continuous suction without further assessment or intervention is not appropriate and could exacerbate the situation.

Connecting the nasogastric tube to suction as prescribed without addressing the presence of "coffee ground" drainage is not appropriate. It's important to assess the significance of this finding before proceeding with suctioning.

Immediately removing and then reinserting the nasogastric tube may not be necessary and could increase the risk of trauma or complications. It's important to assess the situation further and involve the healthcare provider in decision-making.

Difficulty staying asleep may indicate a sleep disorder or psychological stress but is not directly related to the client's diabetes mellitus or hypertension.

Blood pressure of 130/80 mm Hg is within the normal range for adults and does not require further follow-up unless there are specific concerns related to the client's medical history.

Dark yellow urine may indicate dehydration, which could be related to the client's diabetes mellitus and hypertension. However, it is not as concerning as the elevated serum creatininelevel.

Instituting an exercise plan is important for overall health and may be part of the client'streatment plan. However, the primary focus initially should be on addressing disordered eating behaviors and achieving a balanced diet.

Obtaining satisfaction with appearance may be a long-term goal for some individuals with binge eating disorder, but it is not typically the first goal addressed in treatment.

Achieving a steady weight loss may not be appropriate for all individuals with binge eating disorder, as the focus should be on promoting a healthy relationship with food rather than solely on weight loss.

Stomal output of 40 mL in the last hour is within the expected range for output from a newly created stoma and does not typically warrant immediate reporting to the healthcare provider.

C. A red and edematous stomal appearance is normal in the immediate postoperative period and indicates adequate blood supply to the stoma.

Mucous strings floating in the drainage are a common finding after surgical placement of a ureteroileostomy (ileal conduit) and are not typically indicative of a complication requiringimmediate reporting to the healthcare provider.

Assisting the client to recall everyone possibly exposed since the onset of symptoms is important for contact tracing but is not the most immediate action to take.

Teaching the client to wear a mask, hand wash, and social distance to prevent spreading the virus is important for infection control but does not address the immediate need to preventpotential transmission to others in the clinic setting.

Placing the nasal swab specimen for COVID-19 directly into a biohazard bag is appropriate for specimen handling but does not address the need for immediate infection control measures for the client and others in the clinic setting.

Having the client breathe into a paper bag is a technique sometimes used for anxiety-induced hyperventilation but is not appropriate for a client with chronic obstructive lung diseaseexperiencing shortness of breath. It can lead to a buildup of carbon dioxide, worsening the client's condition.

Asking the client to take short, rapid breaths may exacerbate hyperventilation and increase the client's anxiety. This breathing pattern can lead to further respiratory distress in a client withchronic obstructive lung disease.

Increasing oxygen to three L/minute may not be necessary and could potentially lead to oxygen toxicity. The priority is to help the client manage their shortness of breath effectively through breathing techniques.

Explaining the procedure in detail while removing the staples may increase the client's anxiety and discomfort. While education about the procedure is important, it may not be the mosteffective intervention in this situation.

Encouraging the client to continue to verbalize the anxiety acknowledges the client's feelings but may not effectively address the anxiety or alleviate discomfort during the procedure.

Reassuring the client that this is a simple nursing procedure may not be sufficient to alleviate the client's anxiety. The client's perception of the procedure as distressing is valid, and additional measures may be needed to help manage the anxiety and discomfort.

Providing information about the potential for a full recovery with surgery is informative, but it does not address the parent's feelings of guilt or responsibility.

Asking if there's a particular reason why the parent thinks this is their fault may come across as accusatory or dismissive of the parent's feelings. It's important to validate the parent'semotions without implying blame.

"You didn't do anything wrong" is the most helpful response as it validates the parent'sfeelings of guilt or responsibility and reassures them that they are not to blame for their child's condition.