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. Lactulose typically increases the frequency of liquid stools as it helps to draw water into the intestines to facilitate bowel movements.
B. The primary therapeutic goal of lactulose in hepatic encephalopathy is to reduce ammonia levels in the blood, which should result in improved mental status and cognitive function.
C. While lactulose can affect fluid balance, an increase in urine output is not a direct therapeutic response associated with its use.
D. Although improvement in ambulation may occur as the client's mental status improves, it is not the primary expected outcome of lactulose treatment.
Correct Answer is A
Explanation
Rationale:
A. Culturing for sensitive organisms is essential in identifying the causative agent of the infection indicated by the purulent drainage, guiding appropriate antibiotic therapy.
B. Blood pH level is not directly relevant to assessing wound drainage or infection status.
C. C-reactive protein (CRP) can indicate inflammation but is not specific enough to provide immediate information regarding the infection at the wound site.
D. Serum blood glucose level is more relevant for assessing the client's overall metabolic status and risk for infections rather than directly correlating with the purulent drainage observed.