Week 2: Patient Education EAQ

A client who is receiving phenytoin to control a seizure disorder questions the nurse regarding this medication after discharge. How will the nurse respond?</p> "Antiseizure drugs will probably be continued for life." "Phenytoin prevents any further occurrence of seizures." "This drug needs to be taken during periods of emotional stress." "Your antiseizure drug usually can be stopped after a year's absence of seizures."

"Antiseizure drugs will probably be continued for life." Rationale Seizure disorders usually are associated with marked changes in the electrical activity of the cerebral cortex, requiring prolonged or lifelong therapy. Seizures may occur despite drug therapy; the dosage may need to be adjusted. A therapeutic blood level must be maintained through consistent administration of the drug irrespective of emotional stress. Absence of seizures will probably result from medication effectiveness rather than from correction of the pathophysiologic condition.

An infant is to be discharged after surgery for pyloric stenosis. What instructions should the nurse give the parents? "Offer the baby creamy cereal at each feeding, and follow it with a regular formula." "Hold the baby while continuing to feed a regular formula slowly and burp frequently." "Allow the baby to drink about 1 oz (30 mL) of a regular formula per hour for a week, and progress slowly to larger amounts." "Place the baby on the right side in the crib during feedings with regular formula, and minimize handling for 2 hours after feeding."

"Hold the baby while continuing to feed a regular formula slowly and burp frequently." Rationale If there are no complications, the infant resumes regular feedings soon after surgery. The infant does not need special dietary modifications. Also, holding the infant should be encouraged because it is an important part of the parent-child relationship.

A child has cystic fibrosis. Which verbalization by the parents about their plan for the child's dietary regimen provides evidence that they understand the nurse's instructions? Restrict fluids during mealtimes. Discontinue the use of salt when cooking. Provide high-calorie foods between meals. Add whole-milk products from the diet.

Provide high-calorie foods between meals. Rationale: The caloric intake should be 150% to 200% more than the expected intake for size and age because absorption of fats and nutrients is compromised by the disease process. Fluids are encouraged to keep bronchial secretions from becoming too thick and tenacious. Salt is added to the diet to compensate for excessive sodium losses in saliva and perspiration. Whole milk may not be tolerated because of its high fat content; skim milk products should be substituted.

A nurse teaches the mother of a child with a pinworm infestation how pinworms are transmitted. Which statement indicates that the teaching has been effective? "I need to make sure the cat stays off her bed at night." "I'll have to reinforce her hand washing habits, especially before she handles food." "I need to be sure to disinfect the toilet seat after she has a bowel movement for the next few days." "I'll report to the school nurse that the school's dirty toilet seats caused my child to get pinworms."

"I'll have to reinforce her hand washing habits, especially before she handles food." Rationale Pinworms are transferred by way of the anal-oral route; hand washing is the most effective method for preventing transmission. Cats do not transmit pinworms. It is unnecessary to disinfect the toilet seat because pinworms are found in the rectum or colon and travel to the perianal area only when the person sleeps. Dirty toilet seats are not the usual mode of transmission.

A parent receives a note from school reporting that a student in class has head lice. The parent calls the school nurse to ask how to check for head lice. What instruction should the nurse provide? "Ask the child where it itches." "Check to see whether your dog has ear mites." "Look at your child's head along the scalp line for white dots." "Inspect your child's hands and look between the fingers for red lines."

"Look at your child's head along the scalp line for white dots." Rationale The white dots are nits, the eggs of head lice ( Pediculosis capitis); they can be seen on the shaft of hair along the scalp line, behind the ears, and at the nape of the neck. Asking the child where it itches is too vague; objective visualization will confirm the presence of nits. Canine ear mites are not transferable to humans. Red lines between the fingers are a sign of scabies, infestation with the Sarcoptes scabiei mite.

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% chance 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 the baby will be affected and a 50% chance that the baby will be a carrier."

"There is a 25% chance 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.

An IV catheter is to be inserted into a 3-year-old toddler's peripheral vein. As local topical anesthetic is applied, the toddler starts to cry and asks whether the insertion is going to hurt. How should the nurse respond? "Yes, it will hurt, but not for very long." "Maybe it will hurt, but remember that big kids don't cry." "Yes, it may hurt, but if you hold still it won't hurt too much." "It will hurt a little, but I'm good at getting the needle into your arm.

"Yes, it will hurt, but not for very long." Rationale Although the local anesthetic will help minimize the discomfort, the needle insertion may still hurt. Telling the child that the insertion will hurt but not for very long is an honest, simple answer that is appropriate for a 3-year-old child. Telling the child that big kids don't cry is a judgmental response that is inappropriate for a 3-year-old child; children sometimes need to cry to express their feelings. Although the child should hold still, there is no guarantee that doing this will cause the insertion to hurt less. Saying, "Maybe it will hurt" or "It may hurt" constitutes false reassurance. Saying that the insertion will hurt just a little because the nurse is skilled is also false reassurance; there is no guarantee of success, despite the nurse's self-proclaimed expertise.

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.

When teaching an adolescent with type 1 diabetes about dietary management, what instruction should the nurse include? Meals should be eaten at home. Foods should be weighed on a gram scale. A ready source of glucose should be available. Specific foods should be cooked for the adolescent.

A ready source of glucose should be available. Rationale An adolescent with type 1 diabetes must carry a source of simple sugar (e.g., glucose tablets, Insta-Glucose, sugar-containing candy such as LifeSavers) to rapidly counteract the effects of hypoglycemia. This should be followed by a complex carbohydrate and a protein. Stating that meals should be eaten at home is an unrealistic and unnatural instruction for an adolescent. Stating that foods should be weighed on a gram scale is an unnecessary and time-consuming procedure. The adolescent should be made to feel a part of the family; the recommended diet is nutritious and no different from that of the rest of the family.

A client with rheumatoid arthritis has been given a prescription for acetylsalicylic acid. The client asks the nurse, "What kind of drug is acetylsalicylic acid?" The nurse recalls that this drug has which property? Sedative Hypnotic Analgesic Antibiotic

Analgesic Rationale Acetylsalicylic acid (aspirin) acts as an analgesic by inhibiting production of inflammatory mediators. Acetylsalicylic acid does not act as a sedative to calm individuals. Acetylsalicylic acid does not act as a hypnotic to induce sleep. Acetylsalicylic acid does not destroy or control microorganisms.

A 12-year-old child is to be bedridden at home for several weeks after orthopedic surgery. What activity should the nurse encourage the parents to plan? Drawing pictures Playing card games Watching television Continuing schoolwork

Continuing schoolwork Rationale Schoolwork provides the child with a familiar routine; it encompasses the age-appropriate developmental tasks of industry versus inferiority. Drawing pictures is an appropriate activity for the preschooler. Although social interaction and mental stimulation are important at this age, continuing with schooling is the priority. Television watching is satisfactory but should not replace active participation.

While awaiting surgery, a client with a long history of Crohn disease is receiving total parenteral nutrition (TPN) on an outpatient basis. The nurse teaches the client that TPN helps to prepare for surgery by which process? Decreasing fecal bulk Preventing bowel infection Providing stimulation of secretions Maintaining negative nitrogen balance

Decreasing fecal bulk Rationale By decreasing fecal bulk and bowel stimulation, TPN provides rest for the bowel while the client awaits surgery. TPN does not prevent a bowel infection. TPN does not stimulate gastrointestinal secretions. TPN promotes positive nitrogen balance.

What is the priority goal for a client with asthma who is being discharged from the hospital with prescriptions for inhaled bronchodilators? Is able to obtain pulse oximeter readings Demonstrates use of a metered-dose inhaler Knows the healthcare provider's office hours Can identify the foods that may cause wheezing

Demonstrates use of a metered-dose inhaler Rationale Clients with asthma use metered-dose inhalers to administer medications prophylactically or during times of an asthma attack; this is an important skill to have before discharge. Pulse oximetry is rarely conducted in the home; home management usually includes self-monitoring of the peak expiratory flow rate. Although knowing the healthcare provider's office hours is important, it is not the priority; during a persistent asthma attack that does not respond to planned interventions, the client should go to the emergency department of the local hospital or call 911 for assistance. Not all asthma is associated with food allergies.

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.

A client is receiving antibiotics and antifungal medications for the treatment of a recurring vaginal infection. What should the nurse encourage the client to do to compensate for the effect of these medications? Eat yogurt with active cultures daily. Avoid spicy foods. Drink more fruit juices. Take a multivitamin every day.

Eat yogurt with active cultures daily. Rationale Yogurt contains Lactobacillus acidophilus, which replaces the intestinal flora destroyed by antibiotics. Spicy foods, fruit juices, and multivitamins are not relevant to antibiotics or intestinal flora.

A nurse is teaching a high school student about scoliosis treatment options. On what should the nurse focus? Effect on body image Least invasive treatment Continuation with schooling Maintenance of contact with peers

Effect on body image Rationale Establishing an identity, the major developmental task of the adolescent, is related to the affirmation of self-image. To achieve this task there is a need to conform to group norms, one of which is appearance. The type of treatment is not an issue. Although it is important to continue schooling and to maintain contact with peers, the effect on body image is more important.

A client with hyperthyroidism is to receive methimazole. What instructions does the nurse provide? Initial improvement will take several weeks. There are few side effects associated with this drug. This medication may be taken at any time during the day. Large doses are used to quickly correct the functions of the thyroid.

Initial improvement will take several weeks. Rationale Methimazole blocks thyroid hormone synthesis; it takes several weeks of medication therapy before the hormones stored in the thyroid gland are released and the excessive level of thyroid hormone in the circulation is metabolized. There are many common side effects that include nausea, vomiting, diarrhea, rash, urticaria, pruritus, alopecia, hyperpigmentation, drowsiness, headache, vertigo, and fever. Methimazole should be spaced at regular intervals because blood levels are reduced in approximately 8 hours. Large doses cause toxic side effects that can be life threatening, including nephritis, hepatitis, agranulocytosis, leukopenia, thrombocytopenia, hypothrombinemia, and lymphadenopathy.

A client with a suspected dysrhythmia is to wear a Holter monitor for 24 hours at home. What should the nurse instruct the client to do?Keep a record of the day's activities. Avoid going through laser-activated doors. Record the pulse and blood pressure every 4 hours. Delay taking prescribed medications until the monitor is removed.

Keep a record of the day's activities. Rationale: The purpose of monitoring is to correlate dysrhythmias with the client's reported activity. Laser-activated doors have no effect on a Holter monitor and will not affect the readings. Recording the pulse and blood pressure every 4 hours is not required for interpretation of the test. The client should take medication as prescribed and note it in the activities diary.

A client with rheumatoid arthritis asks the nurse why it is necessary to inject hydrocortisone into the knee joint. What reason should the nurse include in a response to this question? Lubricate the joint Reduce inflammation Provide physiotherapy Prevent ankylosis of the joint

Reduce inflammation Rationale: Steroids have an antiinflammatory effect that can reduce arthritic pannus formation. Lubricating the joint does not provide lubrication. Injection of a drug into a joint is not physiotherapy. Ankylosis refers to fusion of joints. It is only indirectly influenced by steroids, which exert their major effect on the inflammatory process.

A nurse is teaching a client about human immunodeficiency virus (HIV). What are the various ways HIV is transmitted? <b>Select all that apply. Mosquito bites Sharing syringe needles Breastfeeding a newborn Dry kissing the infected partner Anal intercourse

Sharing syringe needles Breastfeeding a newborn Anal intercourse Rationale Fluids such as blood and semen are highly concentrated with HIV. HIV may be transmitted parenterally by sharing needles and postnatally through breast milk. HIV may also be transmitted through anal intercourse. HIV is not transmitted by mosquito bites or dry kissing.

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.

A 2-year-old toddler requires close supervision to protect against potential accidents. The nurse teaches a class for parents about the learning style of toddlers. How do toddlers learn self-protection? Through trial-and-error strategies By imitating playmates and siblings By obeying orders from mother and father By playing with age-appropriate toys and puzzles

Through trial-and-error strategies Rationale The toddler is developing autonomy, is curious, and learns self-protection from experience. Toddlerhood play is parallel play, not interactive, play. The struggle for autonomy at this age limits learning from siblings, even though the toddler attempts to copy their behavior. The toddler is still learning from experiences, not from others. The toddler is still attempting to distinguish the self as separate from the parents; the struggle for autonomy limits learning from parents. Toddlers learn gross and fine motor skills as they play with their toys, not self-protection.