The nurse is teaching the mother of a child with cystic fibrosis how to do chest percussion. The nurse should tell the mother to:
- A. Use the heel of her hand during percussion
- B. Change the child's position every 20 minutes during percussion sessions
- C. Do percussion after the child eats and at bedtime
- D. Use cupped hands during percussion
Correct Answer: D
Rationale: Cupped hands during chest percussion create a vibration that helps loosen mucus in cystic fibrosis without causing injury.
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The nurse is performing discharge teaching to a client newly diagnosed with hypertension and high cholesterol. Which statement by the client indicates that the nurse's teaching was effective?
- A. I need to buy canned foods that are low in sodium.
- B. I can substitute lean sirloin for my homemade fried chicken.
- C. I will take a can of soup to work for lunch instead of eating a burger.
- D. Frozen dinners are better for me than eating in the cafeteria at work.
Correct Answer: B
Rationale: Substituting lean sirloin for fried chicken reduces fat and cholesterol. Canned foods, soups, and frozen dinners are often high in sodium, unsuitable for hypertension.
The nurse is teaching a client with a new diagnosis of migraine headaches about trigger avoidance. Which of the following should the client avoid?
- A. Regular exercise.
- B. Aged cheeses.
- C. Fresh fruits.
- D. Daily meditation.
Correct Answer: B
Rationale: aged cheeses contain tyramine, a common migraine trigger
The client with dementia is experiencing confusion late in the afternoon and before bedtime. The nurse is aware that the client is experiencing what is known as:
- A. Chronic fatigue syndrome
- B. Normal aging
- C. Sundowning
- D. Delusions
Correct Answer: C
Rationale: Sundowning is a common phenomenon in dementia where confusion worsens in the late afternoon and evening.
A child who weighs 40 kg is prescribed clarithromycin 15 mg/kg per day for 10 days in two divided doses for acute strep throat. If the medication is provided in suspension with 250 mg/5 mL, how many total milliliters of medication are required to complete the treatment? Record your answer using a whole number.
Correct Answer: 120
Rationale: Daily dose = 15 mg/kg X 40 kg = 600 mg/day. For 10 days, total dose = 600 X 10 = 6,000 mg. Suspension is 250 mg/5 mL, so 1 mg = 0.02 mL. Thus, 6,000 mg X 0.02 mL/mg = 120 mL.
The nurse is caring for a client with a history of breast cancer who is receiving tamoxifen (Nolvadex). The nurse should instruct the client to report which of the following side effects?
- A. Mild nausea.
- B. Hot flashes.
- C. Vaginal bleeding.
- D. Hair thinning.
Correct Answer: C
Rationale: vaginal bleeding is a serious side effect of tamoxifen, as it may indicate endometrial cancer
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