Week 2: Concept of Patient Education EAQ

A nurse in the pediatric clinic is testing a 4-year-old child with recurrent otitis media for signs of hearing loss. The child's parent asks what can be done if there is a hearing loss. The nurse responds that the most common treatment is what? -Myringotomy -Adenoidectomy -Neomycin ear drops -Systemic steroid therapy

-Myringotomy Rationale: Myringotomy is surgical incision of the eardrum to permit drainage of infected middle ear fluid and thus improve hearing. Removal of the adenoids will not relieve the pressure from inflamed ears. Antibiotics are administered systemically, not locally, if needed. Systemic antibiotics, not steroids, are prescribed; a myringotomy is performed if antibiotics are ineffective.

A nurse is teaching the parents of a school-aged child with celiac disease about the nutrients that must be avoided in a gluten-free diet. What nutrients should the nurse teach the parents to avoid? -Saturated oils and fats -Milk and hard cheeses -Corn and rice products -Wheat and oat products

-Wheat and oat products Rationale: Wheat, oats, rye, and barley are major dietary sources of gluten; the gliadin fraction of these grains is not tolerated by individuals with celiac disease. There is no gluten in oils and fats. There is no gluten in cheeses and milk. Corn and rice are used as substitute grains because they do not contain gluten.

The mother of a 4-month-old infant weighing 11 lb (5 kg) asks the nurse how much formula is required per day now that her baby has been weaned from the breast. The recommended caloric intake is 108 kcal/kg, and the formula contains 20 kcal/oz (20 kcal/30 mL). How much formula should the nurse tell the mother to give to her infant each day? -21 oz (630 mL) -27 oz (810 mL) -33 oz (990 mL) -39 oz (1170 mL)

-27 oz (810 mL) Rationale: The infant's daily intake should be approximately 27 oz (810 mL). The infant weighs 11 lb (11/2.2 = 5 kg). An infant's daily caloric need is 108 kcal/kg body weight. 108 kcal × 5 kg = 540 kcal/day; because there are 20 kcal/oz, 540 ÷ 20 = 27 oz (20 kcal/30 mL, 540 ÷ 20 X 30 mL = 810 mL) . Twenty-one ounces (630 mL) is inadequate; 33 (990 mL) oz or 39 (1170 mL) oz is excessive.

A nurse explains to the mother of a 1-year-old with a history of frequent ear infections that the primary cause of otitis media in young children is what? -Sinusitis -Recurrent tonsillitis -An inflamed mastoid process -An obstructed eustachian tube

-An obstructed eustachian tube Rationale: A blocked eustachian tube impairs drainage and creates negative pressure; when the tube opens, bacteria are pulled into the middle ear. Sinusitis is not related to otitis media. Recurrent tonsillitis is not the direct cause of otitis media. Mastoiditis is a complication, not a cause, of otitis media.

An 8-year-old girl who is hospitalized for intravenous antibiotic therapy tells the nurse that she is bored. The nurse has a discussion with the father about appropriate activities. Which activity suggested by the father indicates a need for further teaching? -"I'll bring a radio and CD player." -"I'll bring homework and school supplies." -"She'll enjoy having a rubber baseball and plastic bat." -"She'll enjoy rubber stamps and a pretty box to keep them in."

-"She'll enjoy having a rubber baseball and plastic bat." Rationale: Playing with a bat and ball is an unsafe activity in a hospital setting; the IV catheter could be dislodged, and boisterous activity is dangerous to the other children on the unit. A radio and CD player, homework and school supplies, and rubber stamps and a collection box are all appropriate for the school-aged child.

A parent asks a nurse for suggestions because a 2-year-old child wants to take a bath alone. What is the most appropriate suggestion that the nurse should provide? -"Allow the child to wash herself with supervision." -"Distract the child with other activities." -"Instruct the child on how to take a bath alone." -"Punish the child for insisting on taking a bath alone."

-"Allow the child to wash herself with supervision." Rationale: The parent should allow the child to take a bath alone, but should keep an eye over the child to prevent any adverse events. It will help the child in the learning process. The parent should not distract the child with other activities, because the child may become frustrated. The parent should not punish the child if he or she insists on taking a bath alone, because this will induce a sense of fear in the child.

Intestinal infestation with Enterobius vermicularis (pinworm) is suspected in a 6-year-old child. The nurse asks the parents to assist in confirming the child's diagnosis. What does the nurse instruct the parents to do? -Collect stools for three consecutive days for culture. -Perform an anal cellophane tape test early in the morning. -Schedule hypersensitivity test of the child's blood serum. -Send a sample of the child's stools to the laboratory for testing.

-Perform an anal cellophane tape test early in the morning. Rationale: Pinworms emerge nocturnally to lay eggs in the perianal area; eggs are caught on cellophane tape in the morning before toileting. Laboratory tests of the stool will not reveal an infestation of pinworms. Hypersensitivity tests are not used to diagnose pinworms. A stool culture will not reveal the presence of parasites.

A preschool child is found to have atopic dermatitis. The nurse emphasizes that the child should be discouraged from scratching. The child's mother asks why scratching should be prevented. What is the nurse's response? -"Scratching causes lesions to become more contagious." -"Scratching spreads dermatitis to other areas of the body." -"Scratching results in skin breaks that can lead to infection." -"Scratching produces changes that are precursors to skin cancer."

-"Scratching results in skin breaks that can lead to infection." Rationale: Scratching can break the integrity of the skin, leaving it vulnerable to infection. Dermatitis is a response to an allergen; it is not contagious. Scratching will not cause the dermatitis to spread. There are no data to indicate that scratching or dermatitis is a precursor to skin cancer.

A nurse explains to the parents of a 6-year-old child with a pinworm infestation how pinworms are transmitted. What statement indicates that the teaching has been understood? -"We need to keep the cat off the bed." -"She needs to wash her hands before eating anything." -"She needs to cover her mouth whenever she coughs." -"We need to tell the school so that the cafeteria can be cleaned."

-"She needs to wash her hands before eating anything." Rationale: Pinworm infestation is transferred by way of the oral-anal route, and effective hand washing is the best way to prevent transmission. Cats do not transmit pinworms. The hands should be kept away from the nose and mouth; the child should be taught to cough into a tissue or the inside elbow of the arm. Cleaning the cafeteria is not an effective means of preventing the transmission of pinworms.

A client who is considering sclerotherapy asks the nurse to explain what causes varicose veins. Which response by the nurse is best? -"The cause is abnormal configurations of the veins." -"The cause is incompetent valves of superficial veins." -"The cause is decreased pressure within the deep veins." -"The cause is atherosclerotic plaque formation in the veins."

-"The cause is incompetent valves of superficial veins." Rationale: Incompetent valves result in retrograde venous flow and subsequent dilation of veins. Abnormal configurations of the veins are considered a result of, rather than a cause of, varicose veins. Pressure within the deep veins is increased, not decreased. Plaque formation is considered an arterial, rather than a venous, problem and is associated with atherosclerosis.

A 17-year-old adolescent was recently found to have type 2 diabetes mellitus. What information will the nurse include when providing education to the family? -"Your teen will need insulin injections for the rest of her life." -"The most important interventions are good nutrition and portion control." -"This is a condition where the body produces antibodies against its own cells." -"This condition causes weight loss and increased appetite, thirst, and urination."

-"The most important interventions are good nutrition and portion control." Rationale: Most children with type 2 diabetes are overweight or at risk for becoming overweight. With nutritional intervention to promote proper weight, the condition may often be managed with diet and exercise alone. A lifelong insulin regimen; the production of antibodies against the child's own cells; and weight loss with increased appetite, thirst, and urination are all typical of type 1 diabetes.

A couple at the prenatal clinic for a first visit tells the nurse that their 2-year-old child has just been found to have cystic fibrosis. They state there is no family history of this disorder. They ask the nurse about the chances of their having another child with cystic fibrosis. Knowing that this disorder has an autosomal-recessive mode of inheritance, how should the nurse respond? -"There is a 50% chance that this baby will also be affected." -"If this baby is male, there is a 50% change of his being affected." -"If this baby is female, there is no chance of her being affected, but she will be a carrier." -"There is a 25% chance that the baby will be affected and a 50% chance that the baby will be a carrier."

-"There is a 25% chance that the baby will be affected and a 50% chance that the baby will be a carrier." Rationale: According to Mendelian law, because both parents are carriers, this baby has a 50% chance of being a carrier, a 25% chance of having the disease, and a 25% chance of being unaffected. Because this is an autosomal-recessive gene and not X-linked, there is no difference in prevalence between male and female genetic distribution. Regardless of sex, the infant will have the same risk of being a carrier or noncarrier or having the expressive trait for cystic fibrosis.

In the well-child clinic a nurse teaches a group of parents about guidelines that may prevent Reye syndrome in their preschool-aged children. What should the nurse tell the parents? -"Use a medication other than aspirin when your child has a fever." -"Restrict your child's carbohydrate intake when there are signs of a cold." -"Begin sponge bathing with cold water if your child experiences a high fever." -"You may want to have your child immunized with a recently developed vaccine."

-"Use a medication other than aspirin when your child has a fever." Rationale: Reye syndrome is associated with viral infections, such as influenza or varicella, and commonly follows the ingestion of aspirin during the prodromal stage of these diseases. The child's metabolism is increased during illness; the child should have a high caloric intake. Cold-water sponge baths should not be used; the temperature may decrease too quickly and be too shocking for the child. There is no vaccine to prevent Reye syndrome.

A client admitted to the hospital with an acute episode of rheumatoid arthritis (RA) asks why physical therapy has not been prescribed. What is the most appropriate nursing response? -"Your primary healthcare provider must have forgotten to prescribe it." -"Your condition is not severe enough to have physical therapy approved." -"Your joints are still inflamed, and physical therapy can be harmful." -"Physical therapy is not helpful for persons who suffer from RA."

-"Your joints are still inflamed, and physical therapy can be harmful." Rationale: Rest is required during active inflammation of the joints to prevent injury; once active inflammation has receded, an activity and exercise regimen can begin. Physical therapy is not prescribed during a period of exacerbation because it can traumatize already inflamed joints. The extent of the arthritis is not the determinant; whether the process is in exacerbation or remission is the deciding factor. Physical therapy is helpful, but it is not performed during an acute exacerbation of the arthritis.

The parents of a 6-week-old infant who was born without an immune system ask the nurse why their baby is still so healthy. What is the best response by the nurse? -Exposure to pathogens during this time can be limited. -Some antibodies are produced by the infant's colonic bacteria. -Bottle feeding with soy formula has boosted the immune system. -Antibodies are passively received from the mother through the placenta and breast milk.

-Antibodies are passively received from the mother through the placenta and breast milk. Rationale: Antibodies received in utero through the placenta and by the newborn in the mother's breast milk provide the infant with immunity against most viral, bacterial, and fungal infections during the first several weeks after birth. Then, as the titer of maternal antibodies drops and is not replaced by the infant's own antibodies, prolonged and repeated infections may occur. Limiting exposure to pathogens during this time is not enough to prevent infections in an immunocompromised infant. Bacteria do not produce antibodies. Bottle feeding with soy formula has not been proved to boost immunity in infants.

The nurse is teaching the parents of an infant who will have frequent cast changes about cast care. What suggestion should be included in the teaching? -Assess the skin at the edge of the cast. -Apply lotion to the skin at the cast's edges. -Immerse the cast briefly during the tub bath. -Cover the damp cast edges with adhesive petals.

-Assess the skin at the edge of the cast. Rationale: Rough cast edges can cause skin irritation and breakdown. Lotions applied to the skin at the edges of a cast can also promote skin breakdown. The skin under the cast may become macerated as a result of inadequate drying after water immersion. Adhesive petals will not adhere to a damp cast even if the cast is composed of fiberglass; it takes about a half-hour for it to dry.

A client had a gastric bypass procedure to treat morbid obesity. After surgery the client reports weakness, sweating, palpitations, and dizziness after eating. What should the nurse encourage the client to do? -Reduce the intake of protein-rich foods -Drink 8 ounces (240 mL) of water with meals -Divide the daily caloric intake into six smaller meals -Remain in an upright position for one hour after eating

-Divide the daily caloric intake into six smaller meals Rationale: The client's clinical manifestations are related to the dumping syndrome from the gastric bypass procedure. Smaller meals along with other interventions will help minimize this response. After gastric bypass, a bolus of hypertonic fluid enters the intestines before carbohydrates and electrolytes are diluted. Extracellular fluid is drawn into the bowel lumen; this causes a decrease in plasma volume, distention of the bowel lumen, and rapid intestinal transit. Protein intake should be increased, not decreased, to meet energy needs and promote healing. Fluids should be avoided at mealtimes because they increase the volume in the stomach and decrease the transit time of gastric contents moving from the stomach to the intestine, which contributes to dumping syndrome. An upright position decreases the transit time of gastric contents moving from the stomach to the intestines via gravity, which contributes to the dumping syndrome; clients may lie flat after eating for a short time.

What feeding instruction should a nurse give the parent of a 2-month-old infant with the diagnosis of heart failure? -Use double-strength formula. -Avoid using a preemie nipple. -Refrain from feeding until crying from hunger begins. -Feed slowly while allowing time for adequate periods of rest.

-Feed slowly while allowing time for adequate periods of rest. Rationale: Because of limited exercise tolerance and fatigue, infants with heart failure become too tired to feed; allowing rest and feeding slowly limit the fatigue associated with feeding. Although the infant may be given a formula with a higher caloric value (30kcal/oz (30 kcal/30 mL) rather than 20 kcal/oz (20 kcal/30 mL)), double-strength formula is too high an osmotic load for the infant. A soft nipple used for preterm infants or a regular nipple with an enlarged opening is preferred to conserve the energy required for sucking. Crying consumes energy and is exhausting. The infant should be fed when exhibiting signs of hunger, such as sucking on a fist.

A nurse is planning to teach the four-point alternate crutch gait to a 9-year-old child with cerebral palsy. How does the nurse explain this choice to the parents? -The child has minimal step ability in the lower extremities. -It provides for two points of support on the floor at all times. -It provides for equal but partial weight bearing on each limb. -The child has more power in the upper extremities than the lower extremities.

-It provides for equal but partial weight bearing on each limb. Rationale: The four-point alternate crutch gait is a simple, slow, stable gait because there are always three points of support on the floor, with equal but partial weight bearing on each limb. The child has the ability to move, but the movement in the lower extremities is uncoordinated. The four-point gait provides for three points of support, not two, at all times. A four-point gait divides weight bearing equally among the limbs.

An 8-year-old child is being given insulin glargine before breakfast. What is the most appropriate information for the nurse to give the parents concerning a bedtime snack? -Offer a snack to prevent hypoglycemia during the night. -Give the child a snack if signs of hyperglycemia are present. -Avoid a snack because the child is being treated with long-acting insulin. -Keeping a snack at the bedside in case the child gets hungry during the night.

-Offer a snack to prevent hypoglycemia during the night. Rationale: Insulin glargine is released continuously throughout the 24-hour period; a bedtime snack will prevent hypoglycemia during the night. Providing a snack when signs of hyperglycemia are present is unsafe because it intensifies hyperglycemia; if hyperglycemia is present, the child needs insulin. Because insulin glargine is a long-acting insulin, bedtime snacks are recommended to prevent a hypoglycemic episode during the night. When hypoglycemia develops, the child will be asleep; the child should eat the snack before going to bed.

A parent asks the nurse what to do when the toddler has temper tantrums. What play materials should the nurse suggest that the child be offered as another means of expressing anger? -Ball and bat -Wad of clay -Punching bag -Pegs and pounding board

-Pegs and pounding board Rationale: A pounding board with pegs to hammer into holes is a safe toy for toddlers because it is fairly large, easy to manipulate, and sturdy. It also provides an acceptable way for anger to be expressed. The child's motor and hand-eye coordination are too immature for the child to use a ball and bat. A wad of clay is not as effective for releasing anger as a pounding board. A punching bag is appropriate for an older child with more mature motor coordination to compensate for a moving object.

After a teaching session a nurse determines that an adolescent with newly diagnosed type 1 diabetes has sufficient knowledge of the disorder. What is the next nursing action? -Setting goals with the client -Developing a rapport with the client -Teaching the client how to give insulin injections -Instructing the client how to monitor blood glucose

-Setting goals with the client Rationale: A negotiation of goals is essential to successful learning; mutual goal-setting provides a focus for learning. A rapport should have developed before teaching of the adolescent about diabetes was started. Teaching the client how to give injections or monitor the blood glucose level is premature. If the client does not identify a specific need or set a goal, motivation may be minimal.

When providing discharge teaching to a client who had a total hip replacement, what should the nurse instruct the client to avoid? -Climbing stairs -Stretching exercises -Sitting in a low chair -Lying prone for more than 15 minutes

-Sitting in a low chair Rationale: Excessive flexion of the hip can cause dislocation of the femoral head. Climbing stairs should not cause undue strain on the operative site. Stretching exercises should be encouraged as long as no extremes of position are implemented. The client is permitted to lie prone for more than 15 minutes; lying prone should be encouraged because it prevents hip flexion contractures.

A client with a history of a pulmonary embolus is to receive 3 mg of warfarin daily. The client has blood drawn twice weekly to ascertain that the international normalized ratio (INR) stays within a therapeutic range. The nurse provides dietary teaching. Which food selected by the client indicates that further teaching is necessary? -Poached eggs -Spinach salad -Sweet potatoes -Cheese sandwich

-Spinach Salad Rationale: Dark green, leafy vegetables are high in vitamin K. Influencing the level of vitamin K alters the activity of warfarin because vitamin K acts as a catalyst in the liver for the production of blood-clotting factors and prothrombin. The intake of foods containing vitamin K must be consistent to regulate the warfarin dose so that the INR remains within the therapeutic range. Eggs contain protein and are permitted on the diet. Yellow vegetables contain vitamin A and are permitted on the diet. Dairy products containing protein and bread supplying carbohydrates are permitted on the diet.

What can a nurse do to help confirm a suspected diagnosis of intestinal infestation with pinworms in a 6-year-old child? -Teach the mother the procedure for an anal cellophane tape test -Ask the mother to collect stools for 3 consecutive days for culture -Have the mother bring in the child's stools for visual examination for 3 days -Help the mother schedule a hypersensitivity test of the child's blood serum

-Teach the mother the procedure for an anal cellophane tape test Rationale: Pinworms emerge nocturnally to lay eggs in the perianal area; eggs are transferred onto transparent tape in the morning before toileting. A culture will not reveal the presence of parasites. Ova cannot be seen with the naked eye; the parasite is rarely observed in the stool. A hypersensitivity test is not a test to diagnose pinworms.