which of the following foods can cause diarrhea when eaten by a client with an ileostomy
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Nursing Elites

NCLEX-PN

Next Generation Nclex Questions Overview 3.0 ATI Quizlet

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

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.

2. The nurse is caring for a client recovering from a stroke who recently regained consciousness. The client is having difficulty communicating verbally with the team. Which of the following actions would be least appropriate?

Correct answer: C

Rationale: In this scenario, the least appropriate action would be to wait for the physician's order for speech therapy before assisting with the appropriate documentation. The nurse should start by collecting client data without needing the physician's order, use documents to provide information for the referral, and actively participate in the client referral process. Waiting for the physician's order unnecessarily delays potentially crucial therapy for the client's recovery, affecting the timeliness and effectiveness of care. Therefore, choice C is the least appropriate as immediate action is required in such situations.

3. Why is accurate documentation of assessment findings regarding pressure ulcers crucial?

Correct answer: D

Rationale: Accurate documentation of assessment findings regarding pressure ulcers is crucial because the nursing assessment of ulcers is a standard practice in nursing care. Documenting these findings not only ensures continuity of care but also plays a vital role in preventing further progression of the ulcer. Choices A, B, and C are incorrect because while laws, hospital policies, and physician requirements may influence documentation practices, the primary reason for accurate documentation lies in the standards of nursing practice and the quality of patient care.

4. Why is client and family communication and education concerning restraints essential?

Correct answer: C

Rationale: Client and family communication and education concerning restraints are essential to encourage cooperation. When the client and family understand the purpose and expected benefits of restraints, they are more likely to cooperate. This understanding can help prevent well-meaning family members from releasing restraints due to confusion or lack of information. Therefore, choice C is correct. Choices A, B, and D are incorrect because confusing both groups further, helping with coping and stress levels, and shifting responsibility to the client and family are not the primary goals of communication and education concerning restraints.

5. A nurse is assisting with data collection of a client who has sustained circumferential burns of both legs. What should the nurse examine first?

Correct answer: B

Rationale: The priority assessment for a client with circumferential burns to the legs is to examine peripheral pulses. This is essential to ensure adequate circulation to the extremities. Circumferential burns can lead to compartment syndrome, causing decreased circulation to the affected limbs. Checking peripheral pulses is crucial to monitor for any signs of compromised circulation. While heart rate and blood pressure are important assessments in general, in the context of circumferential burns, the immediate concern is the risk of impaired circulation to the extremities. Therefore, assessing peripheral pulses takes precedence in this situation.

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