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You are caring for an adult patient who has developed a mild oral yeast infection following chemotherapy. What actions should you encourage the patient to perform? Select all that apply.
- A. Use a lip lubricant.
- B. Scrub the tongue with a firm-bristled toothbrush.
- C. Use dental floss every 24 hours.
- D. Rinse the mouth with normal saline. E) Eat spicy food to aid in eradicating the yeast.
Correct Answer: A
Rationale: A. Using a lip lubricant can help keep the lips moist and prevent further irritation caused by the yeast infection.
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The nurse is caring for a 52-year-old woman whose aunt and mother died of breast cancer. The patient states, My doctor and I talked about Tamoxifen to help prevent breast cancer. Do you think it will work? What would be the nurses best response?
- A. Yes, its known to have a slight protective effect.
- B. Yes, but studies also show an increased risk of osteoporosis.
- C. You wont need to worry about getting cancer as long as you take Tamoxifen.
- D. Tamoxifen is known to be a highly effective protective measure.
Correct Answer: A
Rationale: The nurse's best response should be to provide accurate information and manage the patient's expectations realistically. Tamoxifen is known to have a slight protective effect in reducing the risk of developing breast cancer in high-risk individuals like the patient in the scenario. However, it is not a guarantee against developing breast cancer. It is essential for the nurse to convey this information to the patient to ensure that she understands the benefits and limitations of Tamoxifen therapy. Additionally, discussing potential side effects and risks associated with Tamoxifen, such as an increased risk of osteoporosis, is important for the patient to make an informed decision about her health care.
A nurse is examining a patient who has been diagnosed with a fibroadenoma. The nurse should recognize what implication of this patients diagnosis?
- A. The patient will be scheduled for radiation therapy.
- B. The patient might be referred for a biopsy.
- C. The patients breast mass is considered an age-related change.
- D. The patients diagnosis is likely related to her use of oral contraceptives.
Correct Answer: B
Rationale: A fibroadenoma is a benign breast tumor commonly found in young women. In most cases, a fibroadenoma does not require radiation therapy. However, the patient might be referred for a biopsy to confirm the diagnosis and rule out any potential malignancy. While fibroadenomas can be related to hormonal changes in the body, they are not directly linked to the use of oral contraceptives. Recognizing this implication of the patient's diagnosis is essential for providing appropriate care and follow-up.
A 60-year-old patient with a diagnosis of prostate cancer is scheduled to have an interstitial implant for high-dose radiation (HDR). What safety measure should the nurse include in this patients subsequent plan of care?
- A. Limit the time that visitors spend at the patients bedside.
- B. Teach the patient to perform all aspects of basic care independently.
- C. Assign male nurses to the patients care whenever possible.
- D. Situate the patient in a shared room with other patients receiving brachytherapy.
Correct Answer: A
Rationale: The patient undergoing interstitial implant for high-dose radiation (HDR) for prostate cancer will emit radiation that poses a risk to others. Limiting the time that visitors spend at the patient's bedside is essential to minimize their exposure to radiation. It is important to follow safety measures to protect both the patient and others from potential harm. Other options such as teaching the patient to perform basic care independently, assigning male nurses, or situating the patient in a shared room with other brachytherapy patients do not directly address the safety concern of radiation exposure to visitors.
A nurse needs to begin discharge planning fora patient admitted with pneumonia and a congested cough. When is the besttime the nurse should start discharge planningfor this patient?
- A. Upon admission
- B. Right before discharge
- C. After the congestion is treated
- D. When the primary care provider writes the order
Correct Answer: A
Rationale: The best time for a nurse to start discharge planning for a patient admitted with pneumonia and a congested cough is upon admission. Starting discharge planning early allows the healthcare team to identify the patient's needs, plan for the appropriate level of care, and ensure a smooth transition out of the hospital. Waiting until right before discharge or after the congestion is treated may lead to rushed or incomplete planning, potentially compromising the patient's recovery and post-discharge care. Additionally, discharge planning is not dependent on the primary care provider writing an order, as nurses can initiate teaching and planning proactively to support the patient's optimal recovery and transition. By beginning discharge planning upon admission, the healthcare team can address any potential barriers to discharge and ensure the patient's needs are met for a successful recovery process.
A child has been experiencing recurrent episodes of acute otitis media (AOM). The nurse should anticipate that what intervention is likely to be ordered?
- A. Ossiculoplasty
- B. Insertion of a cochlear implant
- C. Stapedectomy
- D. Insertion of a ventilation tube
Correct Answer: D
Rationale: Recurrent episodes of acute otitis media (AOM) can cause fluid accumulation in the middle ear, leading to hearing loss and increased risk of further infections. Insertion of a ventilation tube, also known as a tympanostomy tube, is a common intervention for children with recurrent AOM. This procedure involves placing a tiny tube through the eardrum to allow ventilation and drainage of fluid from the middle ear. Ventilation tubes help equalize pressure, prevent fluid buildup, and reduce the frequency of ear infections. It can improve hearing and decrease the likelihood of future episodes of AOM. Ossiculoplasty, insertion of a cochlear implant, and stapedectomy are not indicated for recurrent AOM.