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The patient has been diagnosed with diabetes. When admitted, the patient is unkempt and is in need of a bath and foot care. When questioned about hygiene habits, the nurse learns the patient takes a bath once a week and a sponge bath every other day. To provide ultimate care for this patient, which principle should the nurse keep in mind?

A.

All cultures value cleanliness with the same degree of importance.

B.

Patients who appear unkempt place little importance on hygiene practices.

C.

The patient’s illness may require teaching of new hygiene practices.

D.

Personal preferences determine hygiene practices and are unchangeable.

Answer and Explanation

The Correct Answer is C

A. Cultural values regarding cleanliness vary, so it is inaccurate to assume uniform standards.  

 

B. Judging the patient as placing "little importance" on hygiene due to appearance can lead to biases and does not consider the patient’s routine.  

 

C. Diabetes may necessitate changes in hygiene practices, especially regarding foot care, to prevent complications. Education on optimal hygiene practices is essential for health management in diabetic patients.  

 

D. While personal preferences influence hygiene, they can be adapted with appropriate education and guidance when necessary for health reasons.


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Correct Answer is D

Explanation

A. An increase in heart rate does not directly affect hemoglobin levels; this option is incorrect.

B. A higher heart rate decreases diastolic filling time, as there is less time for the heart to fill between beats, which can lead to reduced stroke volume.

C. An increased heart rate does not inherently increase stroke volume; in fact, at very high rates, stroke volume can decrease due to reduced filling time.

D. The significant increase in heart rate to 164 beats/min can lead to decreased cardiac output due to compromised diastolic filling and reduced stroke volume.

Correct Answer is B

Explanation

A. Atelectasis is prevented primarily through deep breathing exercises and respiratory interventions, not passive ROM.

B. Passive ROM and splinting help prevent joint contractures by maintaining joint mobility and alignment, so the absence of contractures indicates successful prevention.

C. Pressure ulcers are avoided through regular repositioning and skin care rather than passive ROM alone.

D. Renal calculi are primarily prevented through hydration and diet, not passive ROM or splinting.

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