Nokea
A nurse teaches a client how to avoid becoming ill with Salmonella infection again. Which statements should the nurse include in this client's teaching? (Select all that apply.)
- A. Wash your hands with hot water before eating.
- B. Cook foods thoroughly, especially poultry and eggs.
- C. Wash your hands before and after using the bathroom.
- D. Avoid eating raw or undercooked eggs and meats.
- E. Refrigerate leftovers promptly to prevent bacterial growth.
Correct Answer: B,C,D,E
Rationale: To prevent Salmonella infection, clients should cook foods thoroughly, wash hands before and after bathroom use, avoid raw or undercooked eggs and meats, and refrigerate leftovers promptly to inhibit bacterial growth. Hot water is not specifically required; soap and water are sufficient.
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A nurse assesses a client who has appendicitis. Which clinical manifestation should the nurse expect to find?
- A. A severe steady right lower quadrant pain.
- B. Abdominal pain associated with nausea and vomiting
- C. Marked peristalsis and hyperactive bowel sounds.
- D. Abdominal pain that increases with knee flexion
Correct Answer: A
Rationale: Right lower quadrant pain, specifically at McBurney's point, is characteristic of appendicitis. Nausea and vomiting typically indicate gastroenteritis if they occur first. Marked peristalsis and hyperactive bowel sounds are not typical of appendicitis. Abdominal pain due to appendicitis decreases with knee flexion.
After teaching a client who is prescribed adalimumab (Humira) for severe ulcerative colitis, the nurse assesses the client's understanding. Which statement by the client indicates a need for additional teaching?
- A. I will avoid large crowds and people who are sick.
- B. I will take this medication with my breakfast each morning.
- C. Nausea and vomiting are common side effects of this drug.
- D. I must wash my hands after I play with my dog.
Correct Answer: B
Rationale: Adalimumab (Humira) is administered via subcutaneous injection, not orally with meals. Avoiding crowds and sick individuals, recognizing nausea and vomiting as side effects, and practicing good hand hygiene are correct actions, as adalimumab causes immune suppression.
After teaching a client with perineal excoriation caused by diarrhea from acute gastroenteritis, a nurse assesses the client's understanding. Which statement by the client indicates a need for additional teaching?
- A. I must clean my rectal area with warm water after each stool and apply zinc oxide ointment.
- B. I will clean my rectal area thoroughly with toilet paper after each stool and then apply aloe vera gel.
- C. I must take a sitz bath three times a day and then pat my rectal area gently but thoroughly to make sure I am dry.
- D. I shall clean my rectal area with a soft cotton washcloth and then apply vitamin A and D ointment.
Correct Answer: B
Rationale: Toilet paper can irritate sensitive perineal skin, so warm water rinses or a soft cotton washcloth should be used instead. Aloe vera is not effective for protecting skin from the excoriating effects of liquid stools. The other options describe appropriate care to prevent further irritation.
A nurse cares for a client who is prescribed mesalamine (Asacol) for ulcerative colitis. The client states, 'I am having trouble swallowing this pill.' Which action should the nurse take?
- A. Contact the clinical pharmacist and request the medication in suspension form.
- B. Empty the contents of the medication into suspension or pudding for administration.
- C. Ask the health care provider to prescribe the medication as an enema instead.
- D. Crush the pill carefully and administer it in applesauce or pudding.
Correct Answer: C
Rationale: Asacol is an enteric-coated pill that should not be crushed, chewed, or broken, as this would disrupt its delayed-release mechanism. It is not available as a suspension or elixir. A mesalamine enema (Rowasa) is an alternative formulation that can be prescribed if the client cannot swallow the oral form.
A nurse assesses a client who is hospitalized with an exacerbation of Crohn's disease. Which clinical manifestation should the nurse expect to find?
- A. Positive Murphy's sign with rebound tenderness to palpation
- B. Dull, hypoactive bowel sounds in the lower abdominal quadrant
- C. High-pitched, rushing bowel sounds in the right lower quadrant
- D. Reports of abdominal cramping that is worse at night
Correct Answer: C
Rationale: High-pitched, rushing bowel sounds are expected in Crohn's disease due to narrowing of the bowel lumen. Positive Murphy's sign indicates gallbladder disease, and rebound tenderness suggests peritonitis. Dull, hypoactive bowel sounds and nightly worsening of cramping are not typical of Crohn's disease.