When caring for a toddler with acute lymphocytic leukemia, in which of the following activities should the toddler participate?
- A. Looking at alphabet flashcards.
- B. Playing with a large plastic truck.
- C. Using scissors to cut out paper shapes.
- D. Watching a cartoon in the dayroom.
Correct Answer: B
Rationale: Toddlers with acute lymphocytic leukemia may have compromised immune systems and need to avoid activities that increase infection risk. Playing with a large plastic truck is a safe and engaging activity that does not pose a high risk of infection. This choice also promotes physical activity and creativity, which are beneficial for a toddler's development during illness.
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A client reports that the medication the nurse is administering appears different than what they take at home. Which of the following responses should the nurse take?
- A. Did the doctor discuss with you that there was a change in this medication?
- B. I recommend that you take this medication as prescribed
- C. Do you know why this medication is being prescribed to you?
- D. I will call the pharmacist now to check on this medication
Correct Answer: A
Rationale: When a client reports that the medication appears different than what they take at home, it is crucial for the nurse to ensure the safety and accuracy of the medication being administered. The most appropriate action for the nurse to take in this situation is to call the pharmacist to verify the medication, dosage, and any potential changes. This proactive step helps prevent medication errors and ensures the client's safety and well-being.
A client who is at 38 weeks gestation, is in active labor, and has ruptured membranes is being cared for by a nurse. What action should the nurse take?
- A. Insert an indwelling urinary catheter
- B. Apply fetal heart rate monitor
- C. Initiate fundal massage
- D. Initiate an oxytocin IV infusion
Correct Answer: B
Rationale: When caring for a client in active labor with ruptured membranes, the priority action for the nurse is to apply a fetal heart rate monitor. This helps monitor the well-being of the fetus during labor and delivery, enabling timely interventions if any fetal distress is detected. Inserting an indwelling urinary catheter may be required in some cases, but it is not the priority in the given scenario. Fundal massage is typically done after delivery to help the uterus contract and prevent postpartum hemorrhage. Initiating an oxytocin IV infusion may be indicated to augment labor, but it is not the initial action needed in this situation.
A nurse manager is developing a protocol for an urgent care clinic that often cares for clients who do not speak the same language as clinical staff. Which of the following instructions should the nurse include?
- A. Use a professional interpreter service
- B. Nurse to interpret
- C. Provide translation services for a nominal fee to clients
- D. Evaluate the clients' understanding at regular intervals
Correct Answer: B
Rationale: In situations where there is a language barrier between healthcare providers and patients, it is essential to ensure accurate communication. Using professional interpreter services is the most appropriate choice to ensure clear and precise communication. Relying on the client's children for interpretation may not guarantee accurate or confidential communication. Asking the nurse to interpret can lead to miscommunication or misunderstanding of important medical information. Providing translation services for a nominal fee to clients may not always be feasible or culturally appropriate. Regularly evaluating the client's understanding helps ensure that information is effectively communicated and comprehended.
A client has chronic pancreatitis. Which of the following dietary recommendations should be made?
- A. Coffee with creamer
- B. Lettuce with sliced avocados
- C. Broiled skinless chicken breast with brown rice
- D. None of the above
Correct Answer: C
Rationale: Chronic pancreatitis requires a low-fat diet to reduce stress on the pancreas. Broiled skinless chicken breast with brown rice is a suitable option as it is low in fat. Coffee with creamer and lettuce with sliced avocados are not recommended for individuals with chronic pancreatitis due to their fat content. Choosing options high in fat can exacerbate symptoms and increase the workload on the pancreas, worsening the condition.
While teaching a newly hired nurse about varicella, a nurse in a pediatric clinic should include which of the following information?
- A. Children who have varicella are contagious until vesicles are crusted.
- B. Children who have varicella should receive the varicella (chickenpox) vaccine.
- C. Children who have varicella should be placed in airborne precautions.
- D. Children who have varicella are contagious 1-2 days before the rash appears.
Correct Answer: A
Rationale: Children with varicella (chickenpox) are contagious until all vesicles are crusted over. The contagious period starts 1-2 days before the rash appears and continues until all lesions are dried and crusted. It is important to educate healthcare providers about the contagious period to prevent the spread of the virus to susceptible individuals.