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The nurse is caring for a 1 year-old child who has 6 teeth. What is the best way for the nurse to give mouth care to this child?
- A. Using a moist soft brush or cloth to clean teeth and gums
- B. Swabbing teeth and gums with flavored mouthwash
- C. Offering a bottle of water for the child to drink
- D. Brushing with toothpaste and flossing each tooth
Correct Answer: A
Rationale: Using a moist soft brush or cloth to clean teeth and gums. The nurse should use a soft cloth or soft brush to do mouth care so that the child can adjust to the routine of cleaning the mouth and teeth.
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The nurse is caring for a person who has a nasogastric tube attached to drainage. Which complaint by the client needs to be reported to the charge nurse?
- A. Dry mouth
- B. Weak muscles
- C. Sore throat
- D. Irritated nose
Correct Answer: C
Rationale: A sore throat may indicate nasogastric tube complications like erosion or infection, requiring evaluation. Dry mouth, weakness, or nasal irritation are expected.
A client has returned to the floor from thyroidectomy surgery.
After a client has returned to the floor from thyroidectomy surgery, it is MOST important for the nurse to take which of the following actions?
- A. Monitor vital signs every four hours.
- B. Observe for frequent swallowing.
- C. Monitor for signs of respiratory distress every hour.
- D. Position the client in the supine position.
Correct Answer: C
Rationale: Strategy: Answers are a mix of assessments and implementations. Does this situation require assessment? Yes. Determine what assessment is being made in each answer choice. (1) assessment is not specific to this surgery (2) assessment, method used to monitor for postoperative hemorrhage in a tonsillectomy client (3) correct-assessment, after surgery, swelling can occur, which causes respiratory distress (4) implementation, head of the bed should be elevated
A nursing student asks the nurse manager to explain the forces that drive health care reform. The appropriate response by the nurse manager should include
- A. The escalation of fees with a decreased reimbursement percentage
- B. High costs of diagnostic and end-of-life treatment procedures
- C. Increased numbers of elderly and of the chronically ill of all ages
- D. A steep rise in provider fees and in insurance premiums
Correct Answer: A
Rationale: The escalation of fees with a decreased reimbursement percentage. The percentage of the gross national product representing health care costs rose dramatically with reimbursement based on fee for service. Reimbursement for Medicare and Medicaid recipients based on fee for service also escalates health care costs.
An adolescent for a lumbar puncture.
It is MOST important that the nurse make which of the following statements?
- A. Don't worry because a general anesthetic will be used.'
- B. You can't drink fluids for eight hours before the Test .'
- C. You will remain flat in bed for eight hours after the Test .'
- D. A compression bandage will be in place for ten hours after the Test .'
Correct Answer: C
Rationale: Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired? (1) general anesthetic is not used (2) fluids are not restricted before the Test (3) correct-to prevent a post-lumbar puncture headache, client should remain flat in bed for eight hours after the Test (4) inappropriate for this procedure
Which playroom activities should the nurse organize for a small group of 7 year-old hospitalized children?
- A. Sports and games with rules
- B. Finger paints and water play
- C. Dress-up clothes and props
- D. Chess and television programs
Correct Answer: A
Rationale: Sports and games with rules. The purpose of play for the 7 year-old is developing cooperation. Rules are very important. Logical reasoning and social skills are developed through play.