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a home health nurse is visiting a client who had a stroke 2 months ago. which of the following findings should the nurse report to the interprofessional care team?
- A. the client dresses her affected side first.
- B. the client bears weight on their arms when using crutches
- C. the client coughs when swallowing her medications
- D. the client’s caregiver fills a pill organizer weekly
Correct Answer: D
Rationale: The correct answer is D because it indicates the caregiver's involvement in medication management, which is crucial for a client post-stroke. The nurse should report this to ensure medication adherence and safety. Choice A is not concerning as it shows the client's independence in dressing. Choice B could be a normal weight-bearing technique with crutches. Choice C may indicate dysphagia, which is important but not as immediate as medication management.
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which of the following .........should the nurse include
- A. .............should be placed beside the child’s bed
- B. house hold contacts will receive prophylactic antibiotics
- C. transmission will be emitted because of herd immunity
- D. the child is most contagious after the rash develops
Correct Answer: C
Rationale: The correct answer is C. The nurse should include information about transmission being limited due to herd immunity. This is important because herd immunity occurs when a large portion of the community becomes immune to a disease, reducing the chances of transmission even to those who are not immune. This information is crucial for preventing the spread of infectious diseases within a community.
Choice A is incorrect as it does not provide relevant information about disease transmission or prevention. Choice B is incorrect as it focuses on treatment rather than prevention of transmission. Choice D is incorrect as it provides inaccurate information about the timing of contagion.
A school nurse is planning safety education for a group of adolescents. The nurse should give priority to which of the following topics as the leading cause of death for this age group?
- A. Motor vehicle safety.
- B. Sports injury prevention.
- C. Substance abuse prevention.
- D. Gun safety.
Correct Answer: A
Rationale: The correct answer is A: Motor vehicle safety. Adolescents are at the highest risk of death due to motor vehicle accidents, making it a crucial topic for safety education. This age group is more likely to engage in risky driving behaviors such as speeding, distracted driving, and not wearing seat belts. By focusing on motor vehicle safety, the nurse can address the leading cause of death and help adolescents make safer choices.
Incorrect Choices:
B: Sports injury prevention - While sports injuries are common, they are not the leading cause of death for adolescents.
C: Substance abuse prevention - Substance abuse is a significant concern, but it is not the primary cause of death for this age group.
D: Gun safety - While gun safety is important, it is not the leading cause of death for adolescents.
a nurse is caring for a client who is homeless. which of the following actions should the nurse take first?
- A. determine the clients understanding of her living situation
- B. assist the client to develop goals for obtaining shelter
- C. discuss the risks of being homeless with the client
- D. develop client teaching using a variety of strategies
Correct Answer: C
Rationale: The correct answer is C: discuss the risks of being homeless with the client. This is the first action the nurse should take because it addresses the immediate health and safety concerns of the client. By discussing the risks associated with homelessness, the nurse can help the client understand the potential dangers and motivate them to seek assistance. Option A focuses on assessing the client's understanding, which can come later once immediate risks are addressed. Option B involves future planning and is not the most urgent priority. Option D involves teaching strategies, which may not be effective if the client is not aware of the risks. Therefore, option C is the most appropriate initial action to ensure the client's immediate well-being.
a home health nurse is caring for a client who has chemotherapy induced nausea that has been resistant to relief form 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 theclients 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: D
Rationale: The correct answer is D: offer 120 ml (4 oz.) of cold 2% milk as a meal replacement. Cold milk can help soothe the stomach and provide some relief from nausea. It is important to offer a small amount like 120 ml to prevent overwhelming the digestive system.
A: Using seasonings may worsen nausea due to strong flavors.
B: Ginger ale can contain carbonation which may exacerbate nausea.
C: Elevating the head of the bed is more beneficial for GERD, not chemotherapy-induced nausea.
E: Guided imagery may be helpful for relaxation but may not directly address the nausea.
In summary, offering a small amount of cold milk is the most appropriate intervention as it can help provide relief without exacerbating the nausea.
a nurse is providing education to a group of adolescents who are pregnant and attending high school. which of the following information should the nurse include in theirteaching?
- A. the need for supplemental folic acid is greatest during the third trimester
- B. the incidence of high birth weight infants is higher in adolescent pregnancy
- C. pregnant adolescent need to gain less weight than adult mothers
- D. caffeinated beverages should be replaced with caffeine-free beverages
Correct Answer: A
Rationale: The correct answer is A because during the third trimester, the baby's neural tube is rapidly developing, making folic acid crucial to prevent birth defects. Choice B is incorrect as adolescent pregnancy is associated with higher rates of low birth weight infants, not high birth weight. Choice C is incorrect as pregnant adolescents need to gain a similar amount of weight as adult mothers to support fetal growth. Choice D is incorrect as moderate caffeine intake is generally considered safe during pregnancy.