Question

The nurse is educating a client about the gastrointestinal side effects of Naproxen. Which of the following signs of gastrointestinal upset should the client watch for?

Answer 1

Correct Answers:

Dark, tarry stools

Rationale :

🟢Dark, tarry stools indicate gastrointestinal bleeding, which is a serious adverse effect of Naproxen, a nonsteroidal anti-inflammatory drug (NSAID).

🟢NSAIDs can cause erosion of the gastric mucosa, leading to peptic ulcer formation and GI bleeding.

🟢The presence of melena (black stools) reflects digested blood from the upper gastrointestinal tract.

🟢Older adults and those with prolonged NSAID use are at an increased risk of developing GI complications.

🟢Prompt recognition and reporting of tarry stools allows for timely intervention and prevention of life-threatening hemorrhage.

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Answer 2

Correct Answers:

Consume at least 2000 mL of fluid daily
Increase fresh fruits and vegetables into the diet
Explain the risks of overusing laxatives
Incorporate walking after meals

Rationale :

Consume at least 2000 mL of fluid daily

🟡 Adequate hydration keeps stool soft and easier to pass by improving water content within the colon.

🟡 Older adults have a reduced thirst sensation, so setting scheduled sips helps meet fluid goals.

🟡 Aim for ~2 liters/day unless fluid-restricted (e.g., heart failure, renal disease); clarify any provider limits.

🟡 Warm fluids in the morning can stimulate the gastrocolic reflex, promoting a timely bowel movement.

🟡 Pairing fluids with dietary fiber prevents fiber from hardening the stool and reduces constipation risk.

Increase fresh fruits and vegetables into the diet

🟡 Fruits/vegetables provide soluble and insoluble fiber, which add bulk, retain water, and stimulate peristalsis.

🟡 Increase fiber gradually to limit bloating and gas, while monitoring bowel patterns.

🟡 Whole fruits (e.g., prunes, pears, berries) are more effective than juices due to higher fiber content.

🟡 Most adults benefit from 25–30 g/day of total fiber, adjusted to tolerance and comorbidities.

🟡 Combining fiber with adequate fluids optimizes stool softness and frequency.

Explain the risks of overusing laxatives

🟡 Chronic laxative overuse can cause dependence and reduce the colon’s natural motility (cathartic colon).

🟡 It may lead to electrolyte imbalances (e.g., hypokalemia) that worsen constipation and cause weakness.

🟡 Overuse can impair fluid balance, increasing fall and dehydration risks in older adults.

🟡 Prefer bulk-forming agents and stool softeners first, reserving stimulants for short-term, targeted use.

🟡 Teach to use the lowest effective dose, for the shortest duration, with provider guidance.

Incorporate walking after meals

🟡 Light post-meal ambulation harnesses the gastrocolic reflex, naturally prompting a bowel movement.

🟡 Physical activity increases peristalsis, reducing colonic transit time and stool drying.

🟡 A routine of 10–30 minutes after meals is realistic and supports regularity without straining.

🟡 Build gradually, considering balance and fall risk, and use assistive devices if prescribed.

🟡 Pair activity with hydration and fiber for a synergistic constipation-prevention plan.

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Answer 3

Correct Answers:

Use a turn sheet to position clients in bed
Clean and dry skin after soiling
Consult a dietitian for a nutritional evaluation
Establish an individualized turning schedule

Rationale :

Use a turn sheet to position clients in bed

🔵A turn sheet reduces shear and friction, two principal forces that precipitate pressure injuries.

🔵It enables lifting rather than dragging, preserving the stratum corneum and microvasculature.

🔵Proper use supports spinal alignment and comfort, improving tolerance to repositioning.

🔵It promotes caregiver safety, allowing consistent turns that protect skin integrity.

🔵Combine with off-loading (pillows/heel devices) for comprehensive pressure redistribution.

Clean and dry skin after soiling

🔵Prompt cleansing limits moisture-associated skin damage (MASD) from urine/feces and caustic enzymes.

🔵Use pH-balanced cleansers; avoid vigorous rubbing that increases friction and barrier loss.

🔵Apply barrier creams (e.g., zinc oxide, dimethicone) to protect against ongoing exposure.

🔵Consistent moisture control reduces maceration, lowering risk over the sacrum, coccyx, and perineum.

🔵Integrate with toileting schedules and timely brief changes to keep skin dry.

Consult a dietitian for a nutritional evaluation

🔵Adequate protein and calories support collagen synthesis and tissue repair, preventing breakdown.

🔵A dietitian tailors protein targets (often 1.2–1.5 g/kg/day) and micronutrients (e.g., vitamin C, zinc).

🔵Screening for malnutrition (poor intake, weight loss) identifies those at high risk of ulcers.

🔵Strategies like oral nutrition supplements and texture modifications (for dysphagia) improve intake.

🔵Optimizing hydration and electrolytes complements pressure-offloading and skin care measures.

Establish an individualized turning schedule

🔵Regular repositioning restores capillary perfusion and prevents ischemia at bony prominences.

🔵Use risk tools (e.g., Braden Scale) to set frequency (commonly q2h, but tailored to tolerance and surfaces).

🔵Employ the 30-degree lateral tilt and heel off-loading to minimize direct pressure and shear.

🔵Document turn times, skin findings, and device placement to ensure consistency across shifts.

🔵Combine with support surfaces (high-spec mattresses/overlays) for effective pressure redistribution.

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Answer 4

Correct Answers:

Scabies infestation

Rationale :

♦ Scabies causes intense itching, especially at night, due to the presence of mites burrowing under the skin.

♦ The nurse observes fine, dark, wavy lines (burrows) in skin folds, webs of fingers, axillae, and genital areas, which are classic signs.

♦ The condition is contagious and requires prompt treatment of both the client and close contacts.

♦ Secondary infection can develop from constant scratching, so identification is crucial to prevent complications.

♦ Management involves prescribed scabicidal medication and strict hygiene measures, including washing linens and clothes in hot water.

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Answer 5

Correct Answers:

"I get up four or five times during the night to urinate."

Rationale :

✨Frequent nighttime urination, known as nocturia, interrupts sleep patterns and can lead to insomnia or fragmented sleep.

✨Older adults commonly experience nocturia due to age-related changes in the urinary system or conditions such as enlarged prostate or overactive bladder.

✨Poor sleep quality impacts daytime functioning, cognition, and overall health.

✨Identifying nocturia as a contributor to sleep problems helps the nurse plan interventions such as fluid timing adjustments or referral to a provider.

✨Addressing underlying causes of nocturia can improve restorative sleep and enhance quality of life.

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Answer 6

Correct Answers:

Elbows
Heels
Back of the head
Coccyx

Rationale :

Elbows

🟠The elbows are bony prominences with little natural cushioning, making them highly prone to pressure injuries in immobile clients.

🟠Continuous contact with the bed surface decreases capillary blood flow, causing ischemia and tissue necrosis if unrelieved.

🟠 Friction occurs when a client’s elbows are rubbed against bed linens during movement, further damaging epidermal layers.

🟠 Protective devices such as foam pads or elbow protectors can help reduce direct pressure.

🟠 Regular assessment and repositioning are crucial to prevent skin breakdown at this site.

Heels

🟠 The heels are among the most common sites of pressure injury because they rest directly on the bed in a supine position.

🟠 The Achilles tendon and calcaneus bone lie close to the skin, making tissue more vulnerable to ischemia.

🟠 Off-loading devices, such as heel protectors or pillows under the calves, relieve direct pressure.

🟠 Skin inspection of the heels should be frequent, as injuries here may go unnoticed until advanced.

🟠 Heel ulcers can progress rapidly due to poor perfusion in distal extremities, especially in older adults or diabetic clients.

Back of the head

🟠 The occiput (back of the head) is another bony prominence at risk in clients who lie supine for extended periods.

🟠 Thin tissue covering the skull means sustained pressure quickly compromises circulation, leading to breakdown.

🟠 Infants and frail older adults are especially vulnerable due to limited subcutaneous padding.

🟠 Use of gel pads or specialized pillows helps distribute weight evenly and reduces pressure.

🟠 Frequent repositioning of the head and maintaining proper alignment are important to preserve skin integrity.

Coccyx

🟠 The coccyx and sacrum are primary pressure sites in bedbound clients due to their central contact with the bed surface.

🟠 Prolonged pressure here restricts blood supply and is worsened by shear and friction from sliding down in bed.

🟠 Incontinence increases risk, as moisture and bacteria accelerate skin breakdown in this region.

🟠 Preventive strategies include regular repositioning, barrier creams, and moisture control measures.

🟠 The coccyx is a common site for stage III and IV pressure ulcers, so vigilance in assessment is critical.

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Answer 7

Correct Answers:

Nails will have a yellow appearance and increased thickness .

Rationale :

💠With aging, nails typically develop yellow discoloration due to reduced circulation and keratin changes.

💠Thickened nails (onychomycosis) are common in older adults, often linked to fungal infections or decreased blood supply.

💠These changes make nail care more difficult and may require specialized foot and nail care services.

💠Poor nail health in older adults can lead to pain, impaired mobility, and secondary infection if ignored.

💠Recognition of these changes helps nurses provide preventive care and patient education.

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Answer 8

Correct Answers:

Assess the resident to determine why they are not eating .

Rationale :

🟠The first action is always to perform a thorough assessment before planning interventions.

🟠Identifying the cause—such as depression, oral pain, dysphagia, or dislike of certain foods—guides appropriate care.

🟠Without assessment, interventions may not address the underlying barrier to nutrition.

🟠A nursing assessment provides the foundation for creating an individualized nutrition plan.

🟠Once causes are identified, targeted strategies such as food preferences or supplements can be safely implemented.

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Answer 9

Correct Answers:

"I will make sure that I get my flu vaccine in the spring."

Rationale :

🟥The influenza vaccine should be administered in the fall, before flu season begins, not in the spring.

🟥Vaccination timing is crucial to ensure immunity develops before peak viral transmission.

🟥Misunderstanding the correct timeframe places the client at higher risk of contracting influenza.

🟥Annual immunization is emphasized because influenza strains change each year.

🟥Correct client education reinforces early seasonal vaccination as the standard of care.

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Answer 10

Correct Answers:

Mucopurulent sputum

Rationale :

🟣Clients with tuberculosis (TB) often present with a chronic productive cough producing mucopurulent (thick, pus-filled) sputum.

🟣The sputum may be blood-tinged and is a key sign in pulmonary TB diagnosis.

🟣Persistent productive cough lasting more than 3 weeks is a hallmark clinical finding.

🟣Recognizing this symptom early facilitates isolation precautions and reduces disease transmission.

🟣Nurses should be alert to this sign, especially in clients with risk factors for TB, to initiate prompt evaluation.

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QLexNursing

1 :
The nurse is educating a client about the gastrointestinal side effects of Naproxen. Which of the following signs of gastrointestinal upset should the client watch for?

2 :
Which information will the nurse include in the teaching of an older client who is experiencing constipation? Select all that apply. One, some, or all responses may be correct.

3 :
Which of the following nursing interventions should be applied to reduce the risk of pressure injuries? Select all that apply. One, some, or all responses may be correct.

5 :
Which of the following statements made by an older adult indicates that they are at risk of sleeping problems?

6 :
Which area(s) of the body will the nurse observe for pressure injuries in a bed bound client? Select all that apply. One, some, or all responses may be correct.

7 :
Which finding will the nurse anticipate when assessing the nails of an older adult?

8 :
A resident at a long-term care facility has a poor appetite and has been refusing meals. Which action should the nurse take first to increase the resident's nutritional intake?

9 :
The nurse has provided education about flu vaccines to an older client. Which statement made by the client indicates the need for further teaching?

10 :
Which clinical finding will the nurse anticipate for a client suspected of having tuberculosis?

QLexNursing

1 : The nurse is educating a client about the gastrointestinal side effects of Naproxen. Which of the following signs of gastrointestinal upset should the client watch for?

2 : Which information will the nurse include in the teaching of an older client who is experiencing constipation? Select all that apply. One, some, or all responses may be correct.

3 : Which of the following nursing interventions should be applied to reduce the risk of pressure injuries? Select all that apply. One, some, or all responses may be correct.

5 : Which of the following statements made by an older adult indicates that they are at risk of sleeping problems?

6 : Which area(s) of the body will the nurse observe for pressure injuries in a bed bound client? Select all that apply. One, some, or all responses may be correct.

7 : Which finding will the nurse anticipate when assessing the nails of an older adult?

8 : A resident at a long-term care facility has a poor appetite and has been refusing meals. Which action should the nurse take first to increase the resident's nutritional intake?

9 : The nurse has provided education about flu vaccines to an older client. Which statement made by the client indicates the need for further teaching?

10 : Which clinical finding will the nurse anticipate for a client suspected of having tuberculosis?

1 :
The nurse is educating a client about the gastrointestinal side effects of Naproxen. Which of the following signs of gastrointestinal upset should the client watch for?

2 :
Which information will the nurse include in the teaching of an older client who is experiencing constipation? Select all that apply. One, some, or all responses may be correct.

3 :
Which of the following nursing interventions should be applied to reduce the risk of pressure injuries? Select all that apply. One, some, or all responses may be correct.

5 :
Which of the following statements made by an older adult indicates that they are at risk of sleeping problems?

6 :
Which area(s) of the body will the nurse observe for pressure injuries in a bed bound client? Select all that apply. One, some, or all responses may be correct.

7 :
Which finding will the nurse anticipate when assessing the nails of an older adult?

8 :
A resident at a long-term care facility has a poor appetite and has been refusing meals. Which action should the nurse take first to increase the resident's nutritional intake?

9 :
The nurse has provided education about flu vaccines to an older client. Which statement made by the client indicates the need for further teaching?

10 :
Which clinical finding will the nurse anticipate for a client suspected of having tuberculosis?