Nursing Elites

1. How does cancer affect pain tolerance in elderly clients?

• A. Remain constant.
• B. Decrease.
• C. Increase.
• D. Cancer has no impact on pain tolerance in elderly clients.

Correct answer: B

Rationale: Pain tolerance in elderly clients with cancer is likely to decrease due to factors such as diminished adaptative capacity, increased physical discomfort, and the psychological impact of the disease. Cancer is known to cause various physical and emotional stressors that can lower the pain threshold, leading to a decrease in pain tolerance. Choices A, C, and D are incorrect because cancer and its associated effects typically result in a decrease in pain tolerance rather than remaining constant, increasing, or having no impact.

2. Which of the following statements describes the purpose of client restraint?

• A. Restraints are a nursing measure used to maintain client control.
• B. Restraints are an emergency intervention taken as a last resort to protect a client from imminent danger.
• C. Restraints are a therapeutic measure designed to positively reinforce client behavior.
• D. Restraints are an emergency measure that can only be taken by a nurse under the direct supervision of a physician.

Correct answer: B

Rationale: The correct answer is B. Restraints are used as an emergency intervention when all other options to protect a client from imminent danger have been exhausted. Restraints should only be used as a last resort to ensure the safety of the client and others. Choices A, C, and D are incorrect because restraints are not used to maintain control, reinforce behavior, or are exclusively taken under direct physician supervision. It is crucial to remember that restraint use should always be based on careful assessment, documentation, and adherence to legal and ethical guidelines.

3. Which of the following foods can cause diarrhea when consumed by a client with an ileostomy?

• A. eggs
• B. coffee
• C. fish
• D. garlic

Correct answer: B

Rationale: The correct answer is coffee. Coffee can cause diarrhea in clients with an ileostomy due to its stimulating effect on the digestive system, leading to increased bowel movements. Eggs, fish, and garlic are less likely to cause diarrhea in individuals with an ileostomy. However, they may contribute to odor due to the way they are digested and broken down in the body, affecting the smell of stool output but not necessarily causing diarrhea.

4. Which of the following statements indicates adequate dietary understanding in a client with constipation?

• A. "I should decrease my intake of fluids."?
• B. "I should decrease my level of activity."?
• C. "I should increase my intake of apples."?
• D. "I should increase my intake of milk."?

Correct answer: C

Rationale: The correct answer is, "I should increase my intake of apples."? This statement indicates adequate dietary understanding in a client with constipation because apples are a good source of fiber, which helps alleviate constipation. Adequate fiber intake is essential for promoting bowel regularity. Choices A and B are incorrect as decreasing fluids and activity level can worsen constipation. Insufficient fluid intake can lead to hard stools, exacerbating constipation. Decreasing activity can also slow down bowel movements. Choice D is incorrect because milk is not a high-fiber food and may not effectively address constipation. While milk can have a mild laxative effect on some individuals, it is not a primary solution for constipation, especially when compared to high-fiber foods like apples.

5. Which of the following statements from a client may indicate that they are at a higher risk for a fall?

• A. "I would like to get out of bed but would like to put on my non-skid socks first."?
• B. "Can you make sure the two bedrails are raised before leaving the room?"?
• C. "I think I'm ready to walk a longer distance with the cane today."?
• D. "I need to get out of bed to go to the bathroom now. I cannot find my glasses but cannot wait."?

Correct answer: D

Rationale: The correct answer is 'I need to get out of bed to go to the bathroom now. I cannot find my glasses but cannot wait.' This statement indicates that the client is in a hurry and unable to find their glasses, which could increase the risk of a fall due to impaired vision. Choice A about putting on non-skid socks shows the client's awareness of fall prevention, reducing the risk. Choice B demonstrates the client's request for bedrails to be raised, which is a safety measure, reducing the risk as well. Choice C suggests the client's readiness to walk a longer distance with a cane, indicating progress in mobility but not necessarily a higher fall risk.

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