Nokea
The school nurse is discussing methods to prevent an outbreak of hepatitis A with a group of high school teachers. Which action is the most important to teach the high school teachers?
- A. Do not allow students to eat or drink after each other.
- B. Drink bottled water as much as possible.
- C. Encourage protected sexual activity.
- D. Sing the happy birthday song while washing hands.
Correct Answer: D
Rationale: Handwashing (e.g., for the duration of singing 'Happy Birthday') is the most effective way to prevent fecal-oral transmission of hepatitis A in a school setting. Sharing food/drink is a risk but less critical than hygiene.
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During a home visit, the client’s spouse reports that since her husband’s placement of a colostomy 3 months ago, he has lost interest in golf. She also says he cries often for no reason, sleeps for only a few hours at night, and reports fatigue. The wife asks the nurse for advice. Which statement should be the basis for the nurse’s response?
- A. One in four clients develops depression after ostomy surgery.
- B. Athletic activities like golf are not possible after ostomy surgery.
- C. After 3 months the client should have accepted his new body image.
- D. The smell and location make it difficult to sleep well with an ostomy.
Correct Answer: A
Rationale: The client is exhibiting signs of depression. At least 25% of clients develop clinically significant depression following colostomy. Poor adjustment to a stoma correlates to development of depression.
The nurse is teaching the client diagnosed with colon cancer who is scheduled for a colostomy. Which behavior indicates the nurse is utilizing adult learning principles?
- A. The nurse repeats the information as indicated by the client's questions.
- B. The nurse teaches in one session all the information the client needs.
- C. The nurse uses a video so the client can hear the medical terms.
- D. The nurse waits until the client asks questions about the surgery.
Correct Answer: A
Rationale: Repeating information based on client questions respects adult learning principles by addressing the learner’s needs and reinforcing understanding. One-session teaching, videos, or waiting for questions are less interactive.
The client diagnosed with end-stage liver failure is admitted with esophageal bleeding. The HCP inserts and inflates a triple-lumen nasogastric tube (Sengstaken-Blakemore). Which nursing intervention should the nurse implement for this treatment?
- A. Assess the gag reflex every shift.
- B. Stay with the client at all times.
- C. Administer the laxative lactulose (Chronulac).
- D. Monitor the client's ammonia level.
Correct Answer: B
Rationale: The Sengstaken-Blakemore tube can dislodge or cause complications like aspiration, requiring constant monitoring. Gag reflex, lactulose, and ammonia are unrelated to this intervention.
Which nursing problem is priority for the 76-year-old client diagnosed with gastroenteritis from staphylococcal food poisoning?
- A. Fluid volume deficit.
- B. Nausea.
- C. Risk for aspiration.
- D. Impaired urinary elimination.
Correct Answer: A
Rationale: Fluid volume deficit is the priority in elderly patients with gastroenteritis, as dehydration from vomiting and diarrhea poses significant risks. Nausea, aspiration, and urinary issues are secondary.
The nurse is admitting a client to a medical floor with a diagnosis of adenocarcinoma of the rectosigmoid colon. Which assessment data support this diagnosis?
- A. The client reports up to 20 bloody stools per day.
- B. The client has a feeling of fullness after a heavy meal.
- C. The client has diarrhea alternating with constipation.
- D. The client complains of right lower quadrant pain.
Correct Answer: C
Rationale: Alternating diarrhea and constipation are common in rectosigmoid colon cancer due to partial obstruction by the tumor. Frequent bloody stools are more typical of ulcerative colitis, fullness is nonspecific, and right lower quadrant pain is less likely with rectosigmoid involvement.