A home health nurse is caring for a client who has chemotherapy-induced nausea that has been resistant to relief from pharmacological measures. Which of the following interventions should the nurse initiate? (Select all that apply)
- A. Use seasonings to enhance the flavor of foods
- B. Provide sips of room temperature ginger ale between meals
- C. Maintain the head of the client's bed in an elevated position after eating
- D. Offer 120 ml (4 oz.) of cold 2% milk as a meal replacement
- E. Assist the client in using guided imagery
Correct Answer: B, C, E
Rationale: The correct interventions for the client with chemotherapy-induced nausea are B, C, and E.
B: Providing sips of room temperature ginger ale can help alleviate nausea due to its antiemetic properties.
C: Maintaining the head of the client's bed in an elevated position after eating can prevent acid reflux and reduce nausea.
E: Assisting the client in using guided imagery can help distract from nausea and promote relaxation.
Incorrect choices:
A: Using seasonings may exacerbate nausea in some clients.
D: Offering cold milk as a meal replacement may not be well-tolerated by a nauseated client and could worsen symptoms.
In summary, the correct interventions focus on soothing the stomach, promoting relaxation, and preventing exacerbation of nausea, while the incorrect choices may not directly address the client's symptoms or could potentially worsen them.
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A newly hired occupational health nurse is assessing hazards in the work environment. Which of the following actions will help the nurse detect potential physical hazards?
- A. Track rates of illness caused by infection among employees
- B. Survey workers about job-related emotional stress
- C. Identify industrial toxins that are present in the environment
- D. Measure noise levels at various locations in the facility
Correct Answer: D
Rationale: The correct answer is D: Measure noise levels at various locations in the facility. This action will help the nurse detect potential physical hazards because excessive noise can lead to hearing loss and other health issues. By measuring noise levels, the nurse can identify areas where noise levels exceed safe limits and implement control measures.
Choice A is incorrect as it focuses on illness caused by infections, not physical hazards. Choice B is incorrect as it pertains to emotional stress, not physical hazards. Choice C is incorrect as it focuses on industrial toxins, which are chemical hazards, not physical hazards.
A nurse is counseling a client who is to undergo enzyme-linked immunosorbent assay (ELISA) testing for HIV. Which of the following information should the nurse include?
- A. The test monitors progression of the disease
- B. The test measures antibodies to the virus
- C. The test results are accurate 24 hr after exposure to the virus
- D. A positive result requires initiating immunoglobulin administration
Correct Answer: B
Rationale: The correct answer is B because ELISA testing for HIV measures antibodies to the virus, indicating exposure to the virus. This is crucial for diagnosing HIV infection. Choice A is incorrect because ELISA does not monitor disease progression. Choice C is incorrect as it takes weeks, not hours, for accurate results post-exposure. Choice D is incorrect as immunoglobulin administration is not the treatment for a positive HIV result.
A nurse is working with a community health care team to devise strategies for preventing violence in the community. Which of the following interventions is an example of tertiary prevention?
- A. Presenting community education programs about stress management
- B. Developing resources for victims of abuse
- C. Urging community leaders to make nonviolence a priority
- D. Assessing for risk factors of intimate partner abuse during health examinations
Correct Answer: B
Rationale: The correct answer is B: Developing resources for victims of abuse. Tertiary prevention focuses on minimizing the impact of established disease or injury. By providing resources for victims of abuse, the community health care team is helping to support those who have already experienced violence, thus reducing potential long-term consequences. Choices A, C, and D are examples of primary and secondary prevention strategies, which aim to prevent violence before it occurs or identify and intervene early in cases of violence. These interventions are important but do not fall under tertiary prevention.
A nurse is working with a care manager for a client who participates in a health maintenance organization. The nurse should identify that a health maintenance organization provides which of the following payment structures?
- A. The client is participating in a fee-for-service health care insurance program
- B. The provider is paid a fixed sum for the client on a monthly or yearly basis
- C. The client pays the insurer a percentage of the total costs for each service rendered by the provider
- D. The provider bills the client directly for a predetermined percentage of the cost of services
Correct Answer: B
Rationale: The correct answer is B. In a health maintenance organization (HMO), the provider is paid a fixed sum for the client on a monthly or yearly basis. This payment structure incentivizes providers to focus on preventive care and cost-effective treatments. This model aims to keep clients healthy and reduce unnecessary services.
A: Fee-for-service is not characteristic of an HMO.
C: This describes a cost-sharing model, not typical of an HMO.
D: Providers do not bill clients directly in an HMO.
Which of the following statements should the nurse include in teaching about meningococcal meningitis?
- A. Toothbrush should be placed beside the child's bed
- B. Household contacts will receive prophylactic antibiotics
- C. Transmission will be prevented because of herd immunity
- D. The child is most contagious after the rash develops
Correct Answer: B
Rationale: The correct answer is B: Household contacts will receive prophylactic antibiotics. This statement should be included in teaching about meningococcal meningitis because prophylactic antibiotics are recommended for close contacts to prevent the spread of the infection. This is crucial in preventing outbreaks and protecting others who may have been exposed.
A: Placing a toothbrush beside the child's bed is not relevant to preventing the spread of meningococcal meningitis.
C: Transmission prevention through herd immunity is not a reliable method for controlling the spread of meningococcal meningitis.
D: The child is most contagious before the rash develops, not after, making this statement incorrect.
In summary, teaching about prophylactic antibiotics for household contacts is essential in managing meningococcal meningitis, while the other options do not directly address prevention measures.
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