Nokea
A nurse is providing teaching to the parent of a child who is receiving oral nystatin for oral candidiasis. Which of the following statements by the parent indicates an understanding of the teaching?
- A. I will mix the medication with applesauce
- B. I will provide a snack with the medication
- C. I will store the medication in the refrigerator
- D. I will swab the inside of my child's mouth with the medication
Correct Answer: D
Rationale: The correct answer is D because swabbing the inside of the child's mouth with the nystatin solution is the correct administration method for treating oral candidiasis. Mixing the medication with applesauce or providing a snack with it is not the recommended method of administration. Storing the medication in the refrigerator is also unnecessary and not part of the proper administration instructions.
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A client who has been having frequent tonic-clonic seizures is being admitted by a nurse. Which of the following actions should the nurse add to the client's plan of care?
- A. Apply restraints
- B. Use soft wristbands
- C. Wrap blankets around side rails
- D. Administer sedatives
Correct Answer: C
Rationale: The correct action the nurse should add to the client's plan of care is to wrap blankets around side rails. This helps prevent injury during seizures by providing a cushioned surface against the hard rails. Applying restraints (Choice A) is not recommended as it can cause harm during a seizure. Using soft wristbands (Choice B) may not provide adequate protection against injury. Administering sedatives (Choice D) is not typically indicated for managing tonic-clonic seizures as they require specific anti-seizure medications.
A nurse is caring for an older adult client. The nurse informs the client that straining while defecating can cause which of the following?
- A. Diarrhea
- B. Gastric ulcer
- C. Dilated pupils
- D. Dysrhythmias
Correct Answer: D
Rationale: The correct answer is D: Dysrhythmias. Straining while defecating can lead to dysrhythmias due to increased vagal stimulation. Choices A, B, and C are incorrect. Straining while defecating is not typically associated with causing diarrhea, gastric ulcers, or dilated pupils.
What is a key component of a comprehensive discharge plan for a patient with heart failure?
- A. Advising on appropriate physical activity and exercise
- B. Fluid restriction to prevent fluid overload
- C. Dietary recommendations, including a low-sodium diet
- D. Medication management, including diuretics and ACE inhibitors
Correct Answer: A
Rationale: The main components of a comprehensive discharge plan for a patient with heart failure include advising on appropriate physical activity and exercise to improve cardiovascular health and overall well-being. While fluid restriction and dietary recommendations are important aspects of heart failure management, advising on physical activity and exercise is crucial for improving cardiac function and quality of life post-discharge. Medication management is also essential but focusing on physical activity is particularly relevant for long-term management and preventing readmissions.
A healthcare professional is assessing a client 15 minutes after administering morphine sulfate 2 mg via IV push. The healthcare professional should identify which of the following findings as an adverse effect of the medication?
- A. Drowsy but responsive when her name is called
- B. SaO2 94%
- C. Respiratory rate 8/min
- D. Pain level of 6 on a scale from 0 to 10
Correct Answer: C
Rationale: A respiratory rate of 8/min is a significant adverse effect of morphine that indicates respiratory depression, which requires immediate intervention to prevent further complications. The client may not be effectively ventilating, leading to hypoxia and respiratory acidosis. Option A is less concerning as being drowsy but responsive is a common side effect of morphine. Option B indicates decreased oxygen saturation, which is also a concern but not as severe as respiratory depression. Option D is important but not as critical as the potential respiratory compromise indicated by the low respiratory rate.
A nurse is providing discharge instructions to a client following a gastrectomy. Which of the following strategies should the nurse include in the teaching?
- A. Drink fluids between meals
- B. Eat three large meals each day
- C. Lie down for 30 minutes after meals
- D. Avoid drinking liquids with meals
Correct Answer: D
Rationale: The correct strategy to include in the teaching after a gastrectomy is to avoid drinking liquids with meals. This helps prevent dumping syndrome, a condition characterized by rapid emptying of undigested food and fluids from the stomach into the small intestine. Choices A, B, and C are incorrect. Drinking fluids between meals is appropriate to maintain hydration, eating three large meals can exacerbate dumping syndrome, and lying down after meals is not recommended as it can increase the risk of reflux.