Emerging Care-Management Issues
mononucleosis
Mononucleosis (mono) is a contagious infection caused by a herpes virus called Epstein-Barr. Other viruses can also cause mono. The infection is common among teenagers and young adults. People with mono experience extreme fatigue, fever and body aches.
A client has been admitted for a scheduled bunionectomy. The client has presented the nurse with a detailed interdisciplinary care plan based on internet research that the client has conducted. What is the nurse's best initial response to this client? A. Affirm the client's efforts to engage in their healthcare. B. Educate the client about the fact that the care team normally creates the care plan. C. Assess the client for potential nonadherence to prescribed treatments. D. Compare and contrast the client's care plan with standard preoperative care.
Correct response: Affirm the client's efforts to engage in their healthcare. Explanation: The nurse can best establish a therapeutic relationship with the client by providing affirmation. This will lay a productive foundation for discussing the client's care.
The decision maker for a dying client on hospice care expresses to the nurse that all treatment, including pain medication, should be stopped to allow for natural death to occur. Based on the principles of palliative care, what is the nurse's best explanation about the plan of care for this client? A. "The appropriate method for allowing natural death is to no longer administer fluids." B. "The reason for providing pain medication is to alleviate pain and suffering." C. "The usual end-of-life treatment options are being done as ordered by the health care provider." D. "The interventions being provided do not prevent natural death from occurring."
Correct response: " The reason for providing pain medication is to alleviate pain and suffering." Explanation: The care provided to allow natural death is based on patient comfort and pain management instead of extension of a person's life. Thus, the management of pain, as well as other symptoms, is the established strategy for managing humane and evidence-based palliative care. Since this is the rationale for providing the treatment, this is the best response to the decision maker's concern. A statement that the interventions do not prevent natural death is an assertion that contradicts the decision maker's stated concern, but it does not a supporting rationale and it is unlikely to address the root concern of the decision maker. The administration of fluids can be a comfort measure and does not prevent natural death. Stating that the health care provider's orders are being followed does not give the decision maker adequate information about humane care of the dying.
A nurse is teaching a client about simple wound care. The client insists on using a smartphone to record the procedure. What is the nurse's best response to the client? A. "After you record the video, are you going to post it to the Internet?" B. "I will need to clarify with my manager if you can record the procedure." C. "There are many Internet sites that can serve as a resource for you." D. "That is a great idea then you will know how to do the wound care."
Correct response: "I will need to clarify with my manager if you can record the procedure." Explanation: The use of technology and use of social media should be reviewed with the client. The institution may have a policy regarding the method of discharge instructions for liability purposes. Posting the video to the Internet may be considered a violation of the nurse's privacy if a voice or physical appearance is visible. Suggesting that any Internet site can provide information is not safe for the client's wound care needs. A reputable, evidence-based site should be used. The nurse should not confirm the idea about taping a procedure until the facility approves the use of the client's technology.
A nurse's coworker tells the nurse, "I am not going to get this year's flu vaccination. Last year I felt sick right after I got it." What is the nurse's best response? A. "Reducing your own risk of getting influenza ultimately benefits your clients." B. "If you could guarantee that you will not get influenza for a year, why would you not do it?" C. "I hope you change your mind. I am sure it was just coincidence that you did not feel well after getting it last year." D. "It is our responsibility as healthcare providers to keep vaccinations up to date."
Correct response: "Reducing your own risk of getting influenza ultimately benefits your clients." Explanation: Framing the issue in terms of benefiting clients is likely more effective than making a declaration about professional responsibility. Influenza vaccinations do not confer 100% protection against the disease.
Parents bring a newborn to a well-child check-up and tell the nurse they are concerned about the safety of vaccinations due to a link to autism spectrum disorders. What response by the nurse would be most appropriate? A. Autism spectrum disorders are a genetic problem and not caused by vaccines." B. The concerns with autism spectrum disorders from vaccines are not well supported by research." C. I have never heard of any cases of autism spectrum disorders occurring from vaccines." D. I will tell your pediatrician about your wishes so we can plan your visit."
Correct response: "The concerns with autism spectrum disorders from vaccines are not well supported by research." Explanation: According to the Centers for Disease Control and Prevention (CDC), there is no link between vaccines and autism spectrum disorders, and no evidence exists to support the thinking that vaccine ingredients cause autism spectrum disorders. The parents evidently have concerns, and the nurse needs to address the concerns by providing information about the safety of vaccines. Telling the parents that autism spectrum disorders are a genetic is not helpful to support vaccination. Telling the parents that the nurse has not heard of any cases of autism spectrum disorders occurring from vaccines is inappropriate and does not address the concern or allow for further discussion. Telling the parents that the nurse will inform the pediatrician is inappropriate because it reinforces the misconceptions.
The nurse is walking past the supply room on the hospital unit and sees smoke coming out from below the door. Opening the door, the nurse sees flames. Identify the correct sequence of the nurse's response. All options must be used. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1. Remove from the area anyone who is in immediate risk of harm. 2. Evacuate the area or extinguish the fire, as appropriate to the severity of the fire. 3. Activate the fire alarm. 4. Contain the smoke and fire by closing windows, doors, and curtains.
Correct response: 1. Remove from the area anyone who is in immediate risk of harm. 3. Activate the fire alarm. 4. Contain the smoke and fire by closing windows, doors, and curtains. 2. Evacuate the area or extinguish the fire, as appropriate to the severity of the fire. Explanation: The response to an actual or suspected fire should follow these steps: R: Rescue the client by removing the client or the source of the fire. A: Activate the alarm. C: Confine the fire. E: Evacuate or extinguish, as appropriate to the fire.
A client has been admitted for a scheduled bunionectomy. The client has presented the nurse with a detailed interdisciplinary care plan based on internet research that the client has conducted. What is the nurse's best initial response to this client? A. Affirm the client's efforts to engage in their healthcare. B. Educate the client about the fact that the care team normally creates the care plan. C. Assess the client for potential nonadherence to prescribed treatments. D. Compare and contrast the client's care plan with standard preoperative care.
Correct response: Affirm the client's efforts to engage in their healthcare. Explanation: The nurse can best establish a therapeutic relationship with the client by providing affirmation. This will lay a productive foundation for discussing the client's care.
The nurse is changing the dressing on a client's central venous access device. What actions will the nurse implement for skin antisepsis? Select all that apply. A. Use an alcohol-based solution to cleanse the insertion site. B. Clean the exit site using a back-and-forth motion applying friction. C. Allow the solution to dry completely before applying a new dressing. D. Blot the solution to speed drying time and reduce exposure of the exit site. E. Cover the site with dry gauze dressing followed by occlusive dressing.
Correct response: B. Clean the exit site using a back-and-forth motion applying friction. C. Allow the solution to dry completely before applying a new dressing. Explanation: The cleanser will be applied in a back-and-forth motion with a friction scrub for at least 30 seconds. The nurse allows the solution to dry completely; the site should not be wiped or blotted. The dressing is transparent and occlusive, not gauze. When performing skin antisepsis, the nurse should use chlorhexidine-based antiseptic agents, which provide better skin antisepsis than other agents.
x A child is brought into the emergency department with a severe asthmatic episode by the grandparents who are caring for the child over the weekend while the parents are away. What is the legal consideration(s) for the health care team? Select all that apply. A. Treatment cannot be initiated without the parents' written permission. B. Severe asthmatic episodes can be life-threatening and must be treated immediately. C. A medical power of attorney signed by the parents is acceptable for the grandparents to seek treatment for the child. D. Treatment can be initiated with parental consent by telephone. E. The child needs to have an advance directive to guide treatment.
Correct response: B. Severe asthmatic episodes can be life-threatening and must be treated immediately. C. A medical power of attorney signed by the parents is acceptable for the grandparents to seek treatment for the child. D. Treatment can be initiated with parental consent by telephone.
A child is brought into the emergency department with a severe asthmatic episode by the grandparents who are caring for the child over the weekend while the parents are away. What is the legal consideration(s) for the health care team? Select all that apply. A. Treatment cannot be initiated without the parents' written permission. B. Severe asthmatic episodes can be life-threatening and must be treated immediately. C. A medical power of attorney signed by the parents is acceptable for the grandparents to seek treatment for the child. D. Treatment can be initiated with parental consent by telephone. E. The child needs to have an advance directive to guide treatment.
Correct response: B. Severe asthmatic episodes can be life-threatening and must be treated immediately. C. A medical power of attorney signed by the parents is acceptable for the grandparents to seek treatment for the child. D. Treatment can be initiated with parental consent by telephone. Explanation: The nurse should acknowledge that the need to address life-threatening conditions should take priority over legal or administrative tasks. A medical power of attorney for the grandparents signed by the parents is an acceptable substitution for parental permission within the parameters of the signed document. However, even in the absence of a valid power of attorney, delaying emergency treatment until the parents can be reached is unacceptable practice. Parental consent can be done by telephone. Necessary permissions could be obtained as soon as the responsible party can do so. Children do not have advance directives unless parents have created an advanced directive on behalf of the child. Advanced directives are not needed in this case.
A 7-year-old has just been admitted to the unit for excessive vomiting. Based on the available chart data, what is the nurse's most appropriate action? 10/15 0730 Vital Signs Record T: 104.9° F (40.5° C) P: 98RR: 30 Lab Values Serum Potassium: 3.1 mmol/L Serum Sodium: 128 mmol/L Nurse's Note Skin flushed and warm to touch; good turgor; petechiae noted over entire trunk A. Cover the petechiae with dry sterile dressings. B. Initiate extremity restraints as seizure precautions. C. Suspect that the child has been abused. D. Assess the child's neurological status.
Correct response: D. Assess the child's neurological status. Explanation: Since fever, seizures, vomiting, and petechiae are signs of meningitis, the nurse should promptly assess the child's neurological status and report the findings to the provider. Petechiae does not require dry sterile dressings, nor are they signs of abuse. Restraints are not used as a seizure precautions and the finding of petechiae wouldn't be a reason to initiate seizure precautions. The lab values are just below normal, and would be expected if the child has been vomiting.
The note on the chart of a client with post traumatic stress disorder reads: "During the group therapy session, the client spoke about facts related to the train accident, but did not express their feelings related to the trauma experienced."Based on this chart entry, what is the best strategy for the nurse to use to prompt further discussion during the next group therapy session? A. Encourage the client to explore feelings of survivor guilt and self-blame. B. Address the client's struggle to develop coping skills and sources of support. C. Determine if a history of child abuse prevents discussion of concerns and life events. D. Discuss if the family or other people hold them responsible for what happened.
Correct response: Encourage the client to explore feelings of survivor guilt and self-blame. Explanation: The client needs to recognize that their survival may have been due to chance and not due to a personal action or inaction. Developing coping skills and sources of support do not assist this client with their feelings. Determining if the client has a history of being abused as a child is best asked in a one-on-one interaction, or done in an assessment session prior to a group session. Prior to discussing the involvement and feelings of other people, the client needs to express their feelings about the trauma.
The emergency department healthcare provider diagnoses a middle-aged adult client with a small peri-tonsillar abscess. The client's chart entry reads: Discharge notes 10/15/16 1400 The client is being discharged following a needle aspiration of the peri-tonsillar abscess. Clindamycin 600 mg/bid is ordered, and the client is to take ibuprofen 400 mg/bid as needed for pain. Instructions were given to keep the follow-up appointment. Based on this discharge note, what is the nurse's priority intervention? A. Schedule an X-ray in the next 24 hours after the needle aspiration. B. Give the client a prescription for a follow-up lab test for mononucleosis. C. Tell the client there is a high risk for developing a second abscess. D. Instruct the client to report frequent swallowing or coughing up blood.
Correct response: Instruct the client to report frequent swallowing or coughing up blood. Explanation: Hemorrhage and airway obstruction are the most common complications and must be reported and treated immediately. X-rays are not frequently used in this situation. A culture would be performed on the exudate extracted from the abscess. If symptoms such as multiple swollen lymph nodes, fatigue, or an enlarged spleen are present, a test for mononucleosis would be performed. The risk of developing a second peri-tonsillar abscess is low.
A client diagnosed with acquired immunodeficiency disorder (AIDS) 10 years ago who is now receiving treatment for non-Hodgkin lymphoma asks the nurse, "Why am I getting both chemotherapy and radiation treatments?" What information is important for the nurse to know to answer this question? A. Since only 10% of clients with AIDS develop non-Hodgkin lymphoma, rapid treatment may produce better, even curative results. B. Non-Hodgkin lymphoma occurring in clients with AIDS is usually fast growing and both treatments may bring about an initial positive result. C. The best treatment for AIDS-related non-Hodgkin lymphoma now is the same treatment as those clients without AIDS. D. When non-Hodgkin lymphoma is detected early in the client with AIDS, only a series of chemotherapy treatments is typically used.
Correct response: Non-Hodgkin lymphoma occurring in clients with AIDS is usually fast growing and both treatments may bring about an initial positive result. Explanation: Non-Hodgkin lymphomas in AIDS clients is usually an aggressive disorder and treatment typically consists of both chemotherapy and radiation therapy. Rapid treatment may produce an initial positive response; however, the duration of this positive response is a short period of time. AIDS clients who develop non-Hodgkin lymphoma do not do as well as clients without AIDS due to an altered immune system. Treatment options include chemotherapy, chemotherapy with radiation, stem cell transplantation, or newer therapies in clinical trials.
The pediatric nurse is providing care for an infant who has been diagnosed with respiratory syncytial virus (RSV). What action best prevents the spread of this infectious microorganism? A. Wear a face mask and shield when in close contact with the client. B. Educate the family about the differences between alcohol-based hand rubs and soap and water. C. Wear a gown, gloves, and goggles when providing personal care. E. Administer ribavirin by nebulizer as prescribed.
Correct response: Wear a face mask and shield when in close contact with the client. Explanation: RSV infection necessitates droplet precautions, including the use of a facemask and shield. Goggles are not normally included in droplet precautions. It is important to educate family members and visitors about the need for hand hygiene, but the similarities and differences between the two different methods of performing hand hygiene are not a priority. Antiviral medications such as ribavirin are not commonly used, and they do not directly prevent the spread of the infection.
A hospitalized, older adult client with chronic lung disease has developed hospital acquired pneumonia (HAP). Which assessment finding indicates the occurrence of a problem in treating this client for dehydration? A. disorientation and hunger B. incontinence and agitation l C. depression and lethargy D. coughing and anxiety
Correct response: coughing and anxiety Explanation: When an older adult client is being rehydrated after developing HAP, the nurse monitors for the occurrence of fluid overload. Typical symptoms to monitor for are difficulty breathing, a dry or a productive cough, perspiration, and anxiety. The symptoms of disorientation, hunger, incontinence, agitation, depression and lethargy can occur in the older adult, especially when there are co-occurring health conditions present.
What type of isolation precautions would the nurse request for a child diagnosed with group-A beta-hemolytic streptococcus? A. universal precautions B. droplet precautions C. contact precautions D. airborne precautions
Correct response: droplet precautions Explanation: Group-A beta-hemolytic streptococcal infections are spread through droplets. Standard and contact precautions would not be sufficient to decrease transmission. Group-A beta-hemolytic streptococcal infections do not require specialized masks.
The nurse is evaluating the external fetal monitoring strip of a client in labor. What condition is the nurse concerned about? cephalopelvic disproportion oligohydramnios uteroplacental insufficiency hydramnios
Correct response: uteroplacental insufficiency Explanation: This fetal monitoring strip illustrates a late deceleration. The decrease in fetal heart rate begins after the peak of the contraction and doesn't return to baseline until the contraction is over. Late decelerations are associated with uteroplacental insufficiency, shock, or fetal metabolic acidosis. Cephalopelvic disproportion may cause early, not late, decelerations early in labor. Oligohydramnios be associated with variable decelerations. Hydramnios may be associated with uterine rupture. https://youtu.be/fDeulZdDc_g
A nursing student is assigned to care for a client with HIV. The student asks the staff nurse what precautions are necessary when measuring this client's blood pressure. What is the best information to give the student? wear gloves wear a gown use contact precautions wash hands
Correct response: wash hands Explanation: Because measuring blood pressure doesn't involve contact with the client's blood or secretions, the nursing student should wash the hands before proceeding.