Nokea
A client is newly diagnosed with chronic obstructive pulmonary disease (COPD). The client returns home after a short hospitalization. The home care nurse should most importantly plan teaching strategies that are designed to do what?
- A. Promote membership in support groups.
- B. Encourage the client to become a more active person.
- C. Identify irritants in the home that interfere with breathing.
- D. Improve oxygenation and minimize carbon dioxide retention.
Correct Answer: D
Rationale: Chronic obstructive pulmonary disease (COPD) is a disease state characterized by airflow obstruction. Improving oxygenation and minimizing carbon dioxide retention are the primary goals. The other options are interventions that will help with the achievement of this primary goal.
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The nurse provides instructions to a new mother who is about to breastfeed her newborn infant. The nurse observes the new mother as she breastfeeds for the first time and determines the mother needs further teaching if the new mother applies which technique?
- A. Turns the newborn infant on his side, facing the mother
- B. Tilts up the nipple or squeezes the areola, pushing it into the newborn's mouth
- C. Draws the newborn the rest of the way onto the breast when the newborn opens his mouth
- D. Places a clean finger in the side of the newborn's mouth to break the suction before removing the newborn from the breast
Correct Answer: B
Rationale: The mother should avoid tilting up the nipple or squeezing the areola and pushing it into the newborn's mouth, as this can lead to improper latch or difficulties with milk flow. Turning the newborn on his side facing the mother, drawing the newborn onto the breast when the mouth opens, and breaking suction with a clean finger are appropriate breastfeeding techniques.
The nurse determines that the client with gastroesophageal reflux disease (GERD) needs further teaching regarding diet if which statement is made?
- A. I need to avoid coffee, tea, and chocolate.
- B. I should eat four to six small meals a day.
- C. It is important that I drink extra fluids during meals.
- D. I need to avoid snacking for 2 to 3 hours before bedtime.
Correct Answer: C
Rationale: Gastroesophageal reflux disease (GERD) is the backflow of gastric and duodenal contents into the esophagus. Fluids must be taken between meals rather than with meals to prevent the overdistention that leads to reflux. Coffee, tea, cola, and chocolate are eliminated from the diet because they decrease lower esophageal sphincter pressure and can potentiate reflux. Four to six smaller meals per day will help to prevent gastric overdistention. One of the primary factors in GERD is an incompetent lower esophageal sphincter. Adequate time needs to pass after snacking and before bedtime to decrease the risk for the reflux of gastric contents.
A nurse is caring for a client with dumping syndrome. Which statement by the client indicates a need for further teaching?
- A. I should lie down after I eat my meals.
- B. I may experience weakness and dizziness.
- C. I should eat a low-fat, high-protein, low-carbohydrate diet.
- D. I should eat small meals and avoid drinking fluids with my meals.
Correct Answer: C
Rationale: Dumping syndrome requires a high-fat, low-carbohydrate diet to slow gastric emptying. Other statements are correct.
The nurse is teaching a client diagnosed with histoplasmosis infection about the prevention of future exposure to infectious sources. The nurse determines that the client needs further instruction if the client states that which is a potential source of this infection?
- A. Grape arbors
- B. Bird droppings
- C. Mushroom cellars
- D. Floors of chicken houses
Correct Answer: A
Rationale: Grape arbors do not harbor the causative organism for histoplasmosis. The client diagnosed with histoplasmosis is taught to avoid exposure to potential sources of the fungus, including bird droppings (especially those of starlings and blackbirds), mushroom cellars, and the floors of chicken houses and bat caves.
The nurse has completed discharge teaching with the parents of a child diagnosed with glomerulonephritis. Which statement by the parents indicates that further teaching is necessary?
- A. We'll check our child's blood pressure every day.
- B. We'll test our child's urine for albumin every week.
- C. It'll be so good to have our child back in tap-dancing classes next week.
- D. We'll be sure that our child eats a lot of vegetables and does not add extra salt to food.
Correct Answer: C
Rationale: Tap dancing classes 1 week after discharge would be unrealistic and involve a too rapid increase in activity. Glomerulonephritis results in destruction, inflammation, and sclerosis of the glomeruli of the kidneys. After discharge, parents should allow the child to return to his or her normal routine and activities, with adequate periods allowed for rest. Taking daily blood pressure, testing urine weekly for albumin, and restricting extra sodium are appropriate home care measures.