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A parent of a 9-year-old child newly diagnosed with diabetes mellitus is very concerned about the child going to school and participating in social events. The nurse creating a plan of care should formulate which goals to address these concerns? Select all that apply.
- A. The child's normal growth and development will be maintained.
- B. The child will use effective coping mechanisms to manage anxiety.
- C. The child and family will discuss all aspects of the illness and its treatments.
- D. The child and family will integrate diabetes care into patterns of daily living.
- E. The child and family will discuss their concerns with the child's teachers and the school nurse.
Correct Answer: D,E
Rationale: To effectively manage social events in the child's life, the family and the child need to integrate the care and management of diabetes into their daily living. In addition, the child's teachers and the school nurse should be aware of their concerns. The other options may be appropriate goals, but they do not deal with social issues.
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The nurse is caring for a client with a history of burns. Which of the following psychosocial interventions should be included in the plan of care?
- A. Encourage expression of feelings.
- B. Restrict family visits.
- C. Limit social interactions.
- D. Provide sedatives routinely.
Correct Answer: A
Rationale: Encouraging expression of feelings supports emotional coping in burn recovery.
A client has been taking imipramine [Tofranil] for his depression for 2 days. His sister asks the nurse, 'Why is he still so depressed?' Which of the following responses by the nurse is most appropriate?
- A. Your brother is experiencing a very serious depression.
- B. I'll be sure to convey your concern to his physician.
- C. It takes 2 to 4 weeks for the drug to reach its full effect.
- D. Perhaps we need to change his medication.
Correct Answer: C
Rationale: Imipramine, a tricyclic antidepressant, typically requires 2 to 4 weeks to achieve therapeutic effects as it needs time to alter neurotransmitter levels. This response educates the sister accurately about the medication's timeline.
Thirty minutes after a Sengstaken-Blakemore tube is inserted, the nurse observes that the client appears to be having difficulty breathing. The nurse's first action should be to:
- A. Remove the tube.
- B. Deflate the esophageal portion of the tube.
- C. Determine whether the tube is obstructing the airway.
- D. Increase the oxygen flow rate.
Correct Answer: C
Rationale: Difficulty breathing may indicate airway obstruction by the Sengstaken-Blakemore tube, so assessing this is the priority action.
The nurse is caring for a client with a spinal cord injury at the T4 level. Which of the following findings indicates autonomic dysreflexia?
- A. Bradycardia and hypertension.
- B. Tachycardia and hypotension.
- C. Fever and chills.
- D. Hypoxia and cyanosis.
Correct Answer: A
Rationale: Autonomic dysreflexia presents with bradycardia and hypertension due to unopposed sympathetic stimulation below the injury level.
A client with a history of epilepsy is prescribed phenobarbital. The nurse should monitor the client for which of the following side effects?
- A. Drowsiness.
- B. Hypertension.
- C. Weight gain.
- D. Hyperglycemia.
Correct Answer: A
Rationale: Phenobarbital commonly causes drowsiness, which the nurse should monitor in clients with epilepsy.