A client with newly diagnosed Crohn's disease asks the nurse about dietary restrictions. How should the nurse respond?
Explain that the need to restrict fluids is the primary limitation.
Advise the client to limit foods that are high in calcium and iron.
Describe the use of an elimination diet to find trigger foods.
Instruct the client to avoid foods with gluten, such as wheat bread.
The Correct Answer is C
Rationale:
A. While some clients may need to manage fluid intake based on their symptoms, it is not the primary dietary restriction for Crohn's disease.
B. Clients with Crohn's disease often need to focus on nutrient-rich foods; limiting calcium and iron is not generally advised unless specific deficiencies are present.
C. An elimination diet can help identify trigger foods that exacerbate symptoms, making this response appropriate and beneficial for managing Crohn's disease.
D. Avoiding gluten is specifically related to celiac disease rather than Crohn's disease, as not all individuals with Crohn's need to eliminate gluten unless they have an associated gluten sensitivity.
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Correct Answer is B
Explanation
Rationale:
A. Hyperventilation leads to respiratory alkalosis, not acidosis, as it reduces carbon dioxide levels in the blood.
B. Respiratory acidosis is characterized by the accumulation of carbon dioxide in the blood, leading to a decrease in blood pH. This is the fundamental process underlying respiratory acidosis.
C. While the kidneys can help eliminate carbon dioxide through bicarbonate production, respiratory acidosis primarily results from respiratory failure rather than renal conversion.
D. Elevated blood oxygen levels do not stimulate the respiratory rate; rather, low oxygen levels typically prompt an increased respiratory effort.
Correct Answer is C
Explanation
Rationale:
A. While teaching about eye drops is important, it is not the immediate priority following eye surgery.
B. Obtaining vital signs is essential for overall recovery but is not the most immediate concern related to the eye surgery.
C. Providing an eye shield to be worn while sleeping is crucial to protect the eye after surgery, preventing accidental injury or pressure on the surgical site.
D. Encouraging deep breathing and coughing exercises is important for overall recovery but is not specific to eye surgery and does not address the immediate need for eye protection.