Nokea
A nurse is planning discharge education for a patient who underwent a cervical diskectomy. What strategies would the nurse assess that would aid in planning discharge teaching?
- A. Care of the cervical collar
- B. Technique for performing neck ROM exercises
- C. Home assessment of ABGs
- D. Techniques for restoring nerve function
Correct Answer: A
Rationale: Correct Answer: A - Care of the cervical collar
Rationale:
1. Care of the cervical collar is essential post-cervical diskectomy to ensure proper immobilization and support.
2. Proper care prevents complications and promotes healing.
3. It is a crucial aspect of discharge education to prevent injury and promote recovery.
Summary of other choices:
B: Technique for performing neck ROM exercises - Important for rehabilitation but not directly related to discharge education post-cervical diskectomy.
C: Home assessment of ABGs - Irrelevant to post-cervical diskectomy discharge education.
D: Techniques for restoring nerve function - Important for recovery but not a primary focus of discharge education.
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A child is undergoing testing for food allergies after experiencing unexplained signs and symptoms of hypersensitivity. What food items would the nurse inform the parents are common allergens?
- A. Citrus fruits and rice
- B. Root vegetables and tomatoes
- C. Eggs and wheat
- D. Hard cheeses and vegetable oils
Correct Answer: C
Rationale: The correct answer is C: Eggs and wheat. This is because eggs and wheat are common food allergens in children. Eggs contain proteins that can trigger allergic reactions, while wheat contains gluten, a common allergen. Citrus fruits and rice (choice A) are not common allergens. Root vegetables and tomatoes (choice B) are also less likely to cause allergies. Hard cheeses and vegetable oils (choice D) are not commonly associated with food allergies in children. Therefore, informing the parents about eggs and wheat as common allergens is crucial for the child's testing and management of food allergies.
A nurse administers an antimuscarinic to a patient.Which findings indicate the patient is having therapeutic effects from this medication? (Select all that apply.)
- A. Decrease in dysuria
- B. Decrease in urgency
- C. Decrease in frequency
- D. Decrease in prostate size
Correct Answer: A
Rationale: The correct answer is A: Decrease in dysuria. Antimuscarinic medications target muscarinic receptors, which are involved in the contraction of smooth muscle in the bladder. Dysuria, or painful urination, is a common symptom of overactive bladder or bladder spasms, which can be relieved by antimuscarinics. Choices B, C, and D are related to other urinary symptoms such as urgency, frequency, and prostate size, respectively, which are not directly targeted by antimuscarinics. Therefore, only a decrease in dysuria indicates therapeutic effects of the medication.
A nurse is assessing the skin integrity of a patient who has AIDS. When performing this inspection, the nurse should prioritize assessment of what skin surfaces?
- A. Perianal region and oral mucosa
- B. Sacral region and lower abdomen
- C. Scalp and skin over the scapulae
- D. Axillae and upper thorax
Correct Answer: A
Rationale: The correct answer is A: Perianal region and oral mucosa. In patients with AIDS, these areas are more prone to opportunistic infections due to decreased immune function. The perianal region can be affected by conditions like anal warts or herpes, while the oral mucosa can develop oral thrush or other oral infections. By prioritizing assessment of these areas, the nurse can promptly identify any potential issues and initiate appropriate interventions.
Choice B: Sacral region and lower abdomen are not typically high-risk areas for skin integrity issues in AIDS patients.
Choice C: Scalp and skin over the scapulae are not commonly affected by opportunistic infections related to AIDS.
Choice D: Axillae and upper thorax are not as commonly affected as the perianal region and oral mucosa in AIDS patients.
A patient has just been diagnosed with Parkinsons disease and the nurse is planning the patients subsequent care for the home setting. What nursing diagnosis should the nurse address when educating the patients family?
- A. Risk for infection
- B. Impaired spontaneous ventilation
- C. Unilateral neglect
- D. Risk for injury
Correct Answer: D
Rationale: The correct answer is D: Risk for injury. Patients with Parkinson's disease are at risk for falls due to symptoms like tremors and impaired balance. Educating the family about fall prevention measures is crucial. Choice A, Risk for infection, is not directly related to Parkinson's disease. Choice B, Impaired spontaneous ventilation, is not a common concern in Parkinson's disease. Choice C, Unilateral neglect, is more commonly seen in conditions like stroke, not Parkinson's disease. Therefore, the most appropriate nursing diagnosis for the patient with Parkinson's disease is addressing the risk for injury to prevent falls.
A nurse is teaching patients about health care information. Which patient will the nurse assess closely for health literacy?
- A. A patient 35 years old
- B. A patient 68 years old
- C. A patient with a college degree
- D. A patient with a high-school diploma
Correct Answer: D
Rationale: The correct answer is D because patients with lower health literacy, such as those with a high-school diploma, may struggle to understand complex health information. The nurse should assess this patient closely to ensure they comprehend and can follow instructions. Patients with higher education levels (college degree) may have better health literacy skills. Age alone (35 or 68 years old) does not determine health literacy level. It is essential to focus on the patient's educational background to assess their health literacy effectively.