The healthcare professional is developing a teaching plan for an adolescent with a Milwaukee brace. Which instruction should the healthcare professional include?
- A. Wear the brace over a T-shirt for 23 hours a day.
- B. Remove the brace while sleeping.
- C. Wear the brace directly against the skin.
- D. Remove the brace while eating.
Correct Answer: A
Rationale: The correct answer is A. A Milwaukee brace should be worn over a T-shirt for 23 hours a day to reduce friction and chafing of the skin. This ensures that the brace is not directly against the skin, which can cause discomfort and skin irritation. Choice B is incorrect because the brace should typically be worn continuously, even while sleeping, unless otherwise instructed by a healthcare provider. Choice C is incorrect as wearing the brace directly against the skin can lead to skin issues. Choice D is incorrect since the brace should not be removed while eating to maintain the prescribed wear time.
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The healthcare provider is caring for a client with a chest tube. Which observation indicates that the chest tube is functioning effectively?
- A. Continuous bubbling in the water-seal chamber.
- B. Intermittent bubbling in the suction control chamber.
- C. No fluctuation (tidaling) in the water-seal chamber.
- D. Drainage of clear, pale yellow fluid from the chest tube.
Correct Answer: B
Rationale: Intermittent bubbling in the suction control chamber is the correct observation indicating effective functioning of the chest tube. This bubbling signifies that the suction system is working correctly and maintaining the desired negative pressure in the pleural space. Continuous bubbling in the water-seal chamber suggests an air leak, which is not a normal finding. No fluctuation (tidaling) in the water-seal chamber may indicate a blockage or lack of communication between the pleural space and the water-seal, which is not ideal. Drainage of clear, pale yellow fluid from the chest tube is a normal finding, but it does not specifically indicate the effectiveness of the chest tube function.
During a repeat home visit to see an 84-year-old widow, the nurse discovers that the client is unkempt, smells of stale urine, and does not recognize her neighbors or the nurse. What action should the nurse take?
- A. Call the pharmacy to determine what medications she is taking
- B. Seek the family's assistance in taking care of the client
- C. Complete a physical and mental exam on the client
- D. Call the adult protective services to obtain emergency nursing home placement
Correct Answer: C
Rationale: In this scenario, the nurse should prioritize completing a physical and mental exam on the client. This action is crucial to assess the client's health status comprehensively and identify any underlying issues contributing to her unkempt appearance, odor of stale urine, and confusion. Calling the pharmacy to determine medications (Choice A) may be important but is not the immediate priority. Seeking family assistance (Choice B) can be helpful, but the client's condition requires a thorough assessment first. While adult protective services (Choice D) may be necessary in the future, the immediate action should be to assess the client's physical and mental health status.
The nurse is developing a program to educate parents on the importance of childhood immunizations. Which topic should be prioritized?
- A. the benefits of immunizations
- B. the potential side effects of vaccines
- C. the immunization schedule
- D. ways to comfort children during vaccinations
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Which bioterrorism agent is at high risk for use as a potential biological weapon that i s readily transmitted by several portals of entry?
- A. anthrax
- B. smallpox
- C. botulism
- D. tularemia
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The healthcare provider is caring for a client with a chest tube following thoracic surgery. Which intervention should the healthcare provider include in the plan of care?
- A. Clamp the chest tube for 30 minutes every 2 hours.
- B. Milk the chest tube to ensure patency.
- C. Keep the drainage system at the level of the chest.
- D. Ensure that the chest tube is not clamped or kinked.
Correct Answer: D
Rationale: Ensuring that the chest tube is not clamped or kinked is essential to maintain proper drainage and prevent complications. Clamping the chest tube can lead to a buildup of pressure in the pleural space, causing potential harm to the client. Milking the chest tube is not recommended as it can cause damage to the delicate tubing. Keeping the drainage system at the level of the chest ensures proper drainage by gravity, preventing backflow of fluids, but ensuring the tube is not clamped or kinked takes precedence in this scenario.