A client with a renal calculus reports severe right flank pain, nausea, and vomiting. Which nursing problem has the highest priority?
Acute pain related to renal calculus.
Impaired renal function related to pain.
Risk for aspiration related to vomiting.
Nutritional deficit related to nausea.
The Correct Answer is A
A. Acute pain is the most immediate and pressing problem for the client, given the reported severe flank pain. Managing pain effectively is a primary concern in nursing care, particularly for clients with renal calculi.
B. While impaired renal function is a concern with renal calculi, the acute pain takes precedence as it requires immediate intervention to enhance the client's comfort and promote better overall health.
C. The risk for aspiration is a potential issue due to nausea and vomiting; however, addressing the pain is more urgent in this scenario.
D. Nutritional deficit related to nausea is also a valid concern but is secondary to the acute pain management. The client’s immediate comfort and pain relief should be prioritized to facilitate recovery and improve overall well-being.
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Correct Answer is B
Explanation
A. A soft diet may not provide sufficient fiber, which is essential for managing diverticulosis and preventing complications such as diverticulitis.
B. A high fiber diet helps to bulk up stool and promotes regular bowel movements, reducing the risk of complications associated with diverticulosis. Increased fluid intake is also essential to help fiber work effectively in the digestive system.
C. While sitting up after meals can aid digestion, it is not a primary dietary instruction for managing diverticulosis.
D. A bland diet may not be necessary; the focus should be on increasing fiber intake rather than avoiding specific flavors or spices unless they cause discomfort.
Correct Answer is B
Explanation
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B. Understanding the importance of receiving an influenza vaccine annually is crucial for clients with diabetes, as they are at higher risk for complications from influenza and other infections.
C. While it is important to monitor alcohol consumption, the statement may not indicate full understanding of how alcohol can affect blood glucose levels and the potential need for individualized guidance.
D. While using salt, herbs, and spices can enhance food flavor, it does not specifically address diabetes management, particularly regarding sodium intake for individuals at risk for hypertension.