A nurse is caring for a patient with a nursing diagnosis of Constipation related to slowed gastrointestinal motility secondary to pain medications. Which outcome is most appropriate for the nurse to include in the plan of care?
Patient will have one soft, formed bowel movement by end of shift.
Patient will not take any pain medications this shift.
Patient will walk unassisted to bathroom by the end of shift.
Patient will be offered laxatives or stool softeners this shift.
The Correct Answer is A
A. This outcome is specific, measurable, and directly addresses the goal of managing constipation by aiming for a bowel movement.
B. Discontinuing pain medication abruptly may be unrealistic and can cause distress for the patient.
C. Ambulation may help with constipation but does not directly measure or ensure bowel movement.
D. Offering laxatives or stool softeners is an intervention rather than a measurable patient outcome.
Free Nursing Test Bank
- Free Pharmacology Quiz 1
- Free Medical-Surgical Quiz 2
- Free Fundamentals Quiz 3
- Free Maternal-Newborn Quiz 4
- Free Anatomy and Physiology Quiz 5
- Free Obstetrics and Pediatrics Quiz 6
- Free Fluid and Electrolytes Quiz 7
- Free Community Health Quiz 8
- Free Promoting Health across the Lifespan Quiz 9
- Free Multidimensional Care Quiz 10
View Related questions
Correct Answer is A
Explanation
A. A moderate-carbohydrate diet is recommended because carbohydrates increase CO₂ production during metabolism, and limiting excessive carbohydrate intake can help manage CO₂ retention in patients with respiratory issues.
B. Low-caffeine is not directly related to CO₂ retention and does not influence carbon dioxide levels in the body.
C. High-carbohydrate intake can exacerbate CO₂ production, worsening retention issues in patients with compromised lung function.
D. High-caffeine intake is not related to CO₂ retention management and would not impact CO₂ levels in the respiratory system.
Correct Answer is B
Explanation
A. Performing movements until the patient reports pain is inappropriate in passive range of motion, as the goal is to maintain joint function without causing discomfort.
B. Moving each joint to the point of resistance helps to maintain flexibility and prevent stiffness without causing harm, making this the appropriate technique.
C. Repeating movements five times by the patient is not applicable for passive range of motion, which is performed by the nurse on a patient who cannot do it themselves.
D. While smooth movements are essential, they should not be done quickly; the focus should be on the patient's comfort and safety, avoiding rapid or jerky motions.