A nurse is assessing the volume of liquid nutrition that has been tube-fed to a client. What will happen if the volume of feeding exceeds the client's physiologic capacity?
A) Constipation
B) Pallor
C) Obesity
D) Gastric reflux
D
Feedback:
Overfilling the client's stomach can cause gastric reflux, regurgitation, vomiting, aspiration, and pneumonia. Exceeding the volume of feeding beyond a client's physiologic capacity does not as commonly lead to constipation, pallor, or obesity.
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The nurse knows that when patients are experiencing stress, the following change can be seen in their signs and symptoms: (Select all that apply.)
a. Increase in heart rate b. Increase in gastric motility c. Pupil dilation d. Decrease in blood pressure e. Increase in respiratory rate
A female patient is diagnosed with a right stroke. The patient is now experiencing hemianopsia. How might the nurse help the patient manage her potential sensory and perceptional difficulties?
A) Keep the lighting in the patient's room low. B) Place the patient's clock on the affected side. C) Approach the patient on the side the vision impaired. D) Place the patient's extremities where she can see them.
The nurse has been working with a client of limited financial means. The client states that they don't have much money to buy meat, so the nurse recommends the client focus on foods with high biologic value protein
The nurse knows teaching has been effective when the client says: 1. "We only need about 3 ounces of meat per day per person.". 2. "Eggs might be an inexpensive way to get protein.". 3. "We should consider becoming vegetarian.". 4. "Even if I don't eat meat, my children need it grow normally.".
The patient is receiving an oral antibiotic as treatment for cellulitis of the lower extremity. The patient's outcome is "Patient will state a key point about antibiotic treatment for cellulitis."
Which statement by the patient provides the best evaluation by the nurse at this time? 1. "If the pain gets too bad, I can take my prescribed pain medication." 2. "If the swelling continues, I can apply an ice pack." 3. "I need to take all the pills even if my leg looks better." 4. "I must keep my leg elevated until the swelling goes down."