Practice 3

A nurse is admitting a child and observes multiple irregular bruises. Which action should the nurse take next? 1. Ask parents to leave the room during the admission process [22%] 2. Continue with a detailed interview and physical examination [47%] 3. Notify the charge nurse and the social worker [29%] 4. Promise not to tell anyone if the child reveals abuse [0%]

A nurse who suspects child abuse should conduct a detailed interview and physical examination to identify potential indicators of abuse (Option 2). In addition to obvious injuries, abused children may show extremes in behavior, including being overly shy, fearful, or even unusually affectionate. Parents should remain present during the admission process and the nurse should observe parent-child interactions for signs of abusive behavior (eg, refusal to comfort, blaming, belittling) (Option 1). Abusive parents may be hostile or uncooperative with the health care team. The nurse should also assess for inconsistencies between the parents' report and the actual findings. (Option 3) The nurse should report findings that indicate abuse to the charge nurse, social worker, and health care provider only after conducting a full history and physical examination. (Option 4) The nurse should not make promises of secrecy to the child or family if abuse is revealed. The child or family should be told that the nurse is required by law to report all abuse.

The nurse is reviewing the records of an adolescent client. Which findings suggest that the client may need referral for depression screening? Select all that apply. 1. Client has had school disciplinary issues due to absenteeism and angry outbursts 2. Client has lost approximately 8 lb (3.64 kg) over the last 3 weeks without trying 3. Client is often found sleeping during class or activities 4. Client quit sports despite receiving previous athletic awards and trophies 5. Client voices concern about appearance related to facial acne

Adolescent clients are at increased risk for developing depressive and anxiety-related mood disorders as they begin to identify their role in adult life and develop new personal relationships. However, they frequently report vague somatic symptoms (eg, headache, stomachache) and may exhibit an irritable or cranky mood rather than a sad or dejected mood. Signs of depression in adolescent clients include: Hypersomnolence or insomnia; napping during daily activities (Option 3) Low self-esteem; withdrawal from previously enjoyable activities (Option 4) Outbursts of angry, aggressive, or delinquent behavior (eg, vandalism, absenteeism); inappropriate sexual behavior (Option 1) Weight gain or loss; increased food intake or lack of interest in eating (Option 2) Depression is also a significant cause of suicide in adolescents. (Option 5) Adolescent clients begin to become more aware of body image and may express concern regarding their appearance. It is normal for clients in this age group to experience insecurity about their appearance (eg, acne, body hair). These insecurities do not correlate with the onset of a depressive disorder.

A 75-year-old client is hospitalized with chronic obstructive pulmonary disease (COPD) exacerbation. The health care provider (HCP) initiates noninvasive positive airway pressure ventilation (NIPPV) with a bilevel positive airway pressure (BIPAP) device. Prescribed medications are shown in the exhibit. Which parameter is most important for the nurse to monitor frequently in this client? Click on the exhibit button for additional information. 1. Blood glucose level [37%] 2. Capillary refill time [10%] 3. Extremity swelling [6%] 4. Mental status [45%] Exhibit: Medication prescription Albuterol and ipratropium: nebulizer, every 4 hours as needed Levofloxacin: 750 mg IV, once daily Methylprednisolone: 40 mg IV, every 8 hours Enoxaparin: 40 mg subcutaneously, once daily

An exacerbation of COPD is characterized by the acute worsening of a client's baseline symptoms (eg, dyspnea, cough, sputum color and production). NIPPV is often prescribed short-term to support gas exchange in clients who have moderate to severe COPD exacerbations and acidosis (pH <7.3) or hypercapnia (PaCO2 >45 mm Hg). NIPPV can prevent the need for tracheal intubation and is administered until the underlying cause of the ventilatory failure is reversed with pharmacologic therapy (eg, corticosteroids, bronchodilators, antibiotics). BIPAP involves the use of a mechanical device and facemask in a conscious client who is breathing spontaneously. BIPAP delivers oxygen to the lungs and then removes carbon dioxide (CO2). CO2 retention causes mental status changes. If the client becomes drowsy or confused, it is likely that more CO2 is being retained than what BIPAP can remove; this should be reported to the HCP. Arterial blood gas evaluation should be obtained to determine CO2 level and BIPAP effectiveness. Altered mental status poses the greatest threat to a client's survival as it can lead to decreased protective reflexes (eg, gag, swallow, cough), periods of apnea, and airway compromise (Option 4). (Option 1) The nurse should monitor the blood glucose level because the client was prescribed the corticosteroid methylprednisolone (Solu-Medrol), which can cause hyperglycemia, especially in clients with diabetes mellitus. However, blood glucose is not the most important parameter to monitor frequently in this client. (Option 2) Capillary refill time is indicated to assess poor perfusion states, and a value of >3 seconds (delayed refill time) is seen in conditions such as dehydration, shock, and peripheral vascular disease. (Option 3) Unilateral extremity swelling is concerning for deep venous thrombosis (DVT) in a hospitalized client. Bilateral swelling indicates volume overload or venous stasis. This client was started on enoxaparin (blood thinner) to prevent DVT. Volume overload is unlikely as the client is not receiving IV fluids.

An unaccompanied 16-year-old girl comes to the emergency department with severe abdominal pain and vomiting. The client has a temperature of 102.2 F (39 C) and a pulse of 120/min and is lethargic. The client's parents are out of town, and no guardians can be reached. How should this client's care be handled? 1. Administer care until the parents or guardians can be reached [84%] 2. Admit the client but without giving care until the parents or guardians can be reached [2%] 3. Perform a pregnancy test to see if the client qualifies as an emancipated minor [10%] 4. Provide health care and follow-up advice but do not give any direct care [2%]

An unaccompanied minor should be treated if the medical condition is an emergency and should be assessed and stabilized. This client clearly has a medical need and could suffer consequences if not treated. In this scenario, care should be rendered and then explained later to the parent or guardian. This approach is supported by the ethical principles of beneficence and nonmaleficence. In addition, underage clients may consent in certain circumstances without parental consent. These circumstances usually include treatment for substance abuse problems, psychiatric disorders, or sexual transmitted diseases. (Option 2) This client has signs/symptoms of systemic infection and possible dehydration or sepsis, an emergent condition. It is unknown when the parents or guardians can be reached. It would be negligent to not further assess and treat a potentially worsening condition. It is assumed that the parents or guardians would want safe, quality care for the client. (Option 3) Qualifications for the status of emancipated minor are subject to state legislation but usually include individuals age <18 who are parents or pregnant, married, living as financially independent, or in the military. This client needs care that should be rendered regardless of status. (Option 4) Providing follow-up advice will not stabilize a potentially serious medical condition. Care must be provided.

The nurse administers 15 units of aspart insulin subcutaneously to a hospitalized client with type 1 diabetes mellitus at 7:00 AM for a fasting blood glucose of 180 mg/dL (10 mmol/L). Which nursing action is a priority? 1. Ensure that the client continues to fast for at least 30 more minutes [3%] 2. Give the client breakfast within 15 minutes [80%] 3. Recheck the blood glucose in 1 hour [11%] 4. Teach the client about the signs and symptoms of hyperglycemia [4%]

Aspart (NovoLOG) is a rapid-acting insulin with an onset of 10-15 minutes. Onset is the time it takes for the insulin to enter the circulation and begin to lower blood glucose. The peak effect takes 30 minutes-3 hours and the duration of action is 3-5 hours. It is important for the nurse to ensure that the client eats within 15 minutes of administration of aspart/lispro/glulisine to prevent an insulin-related hypoglycemic reaction (Option 2). (Option 1) The client is at risk for a hypoglycemic reaction if breakfast is delayed for 30 minutes. (Option 3) Rechecking the blood glucose in 1 hour is not indicated unless hypoglycemia is suspected. (Option 4) Teaching is vital, but it is most important to ensure that the client eats breakfast to prevent a hypoglycemic reaction at drug onset.

The nurse is reinforcing discharge teaching for the parents of a 1-year-old with a newly diagnosed cow's milk allergy. Which nutrients normally provided by milk should be obtained from other sources? Select all that apply. 1. Calcium 2. Fiber 3. Iron 4. Vitamin D 5. Vitamin K

Calcium and vitamin D are nutrients in cow's milk that are essential for proper bone development in children and adolescents (Options 1 and 4). To obtain the recommended 500 mg of daily calcium (for ages 1-3 years), the parents should serve foods such as beans, dark green vegetables, and calcium-fortified cereals and juices. Vitamin D, which enhances the absorption of calcium, is synthesized in the skin by exposure to direct sunlight. Alternate dietary sources include fish oils, egg yolks, and vitamin D-fortified foods (eg, orange juice). (Option 2) Fiber, which is important for digestive health, is found in only small amounts in cow's milk. Fiber-rich foods include whole grains, beans, and berries. (Option 3) Cow's milk is not a significant source of iron. Dietary sources of iron include meats and spinach. (Option 5) Vitamin K is an important nutrient for coagulation. Vitamin K is produced by bacteria in the large intestine and is found in food sources such as dark green vegetables, fish, and eggs, not in cow's milk.

In the intensive care unit, the nurse cares for a client who is being treated for hypotension with a continuous infusion of dopamine. Which assessment finding indicates that the infusion rate may need to be adjusted? 1. Central venous pressure is 6 mm Hg [15%] 2. Heart rate is 120/min [56%] 3. Mean arterial pressure is 78 mm Hg [14%] 4. Systemic vascular resistance is 900 dynes/sec/cm-5 [13%]

Dopamine (Intropin) is a sympathomimetic inotropic medication used therapeutically to improve hemodynamic status in clients with shock and heart failure. It enhances cardiac output by increasing myocardial contractility, increasing heart rate, and elevating blood pressure through vasoconstriction. Renal perfusion is also improved, resulting in increased urine output. The lowest effective dose of dopamine should be used as dopamine administration leads to an increased cardiac workload. Significant adverse effects include tachycardia, dysrhythmias, and myocardial ischemia. A heart rate of 120/min may indicate that the dopamine infusion needs to be reduced (Option 2). (Options 1, 3, and 4) These measurements fall within the respective reference ranges and do not indicate a need to adjust dopamine administration. Normal central venous pressure is 2-8 mm Hg; normal mean arterial pressure ([systolic blood pressure + (2 x diastolic blood pressure)]/3) is 70-105 mm Hg; and normal systemic vascular resistance is 800-1200 dynes/sec/cm-5.

The nurse is assessing a client at 36 weeks gestation during a routine prenatal visit. Which statement by the client should the nurse investigate first? 1. "I am not sleeping as well due to cramps in my calves at night." [29%] 2. "I have noticed less kicking movements as the baby grows bigger." [49%] 3. "Over the last few weeks, I have not been able to wear any of my shoes." [17%] 4. "Sometimes I feel short of breath after walking up a flight of stairs." [3%]

Fetal movement is a sign of fetal health and indicates an intact fetal central nervous system. Fetal movement may occur numerous times per hour during the last trimester of pregnancy, although the client may not perceive every movement. Multiple factors (eg, maternal substance abuse, medications, fasting, fetal sleep) can affect fetal movement. However, fetal movements should not decrease as the fetus increases in size. Decreased fetal movement is a potential warning sign of fetal compromise (ie, impaired oxygenation), which may precede fetal death (Option 2). The nurse prioritizes assessment of client reports of decreased fetal movement to evaluate fetal well-being (eg, nonstress test). (Option 1) Leg cramps commonly occur in the third trimester, especially at night, due to the weight of the gravid uterus applying pressure to nerves affecting calf muscles. Home interventions include stretching legs, massaging calves, and increasing fluid intake. (Option 3) Dependent edema in the lower extremities is common in the third trimester due to decreased venous return (gravid uterus pressure on vena cava), especially with prolonged sitting/standing. This is not a priority over decreased fetal movement. (Option 4) As the uterus rises in the third trimester, the diaphragm is prevented from allowing full lung expansion, causing dyspnea, especially with exertion.

The nurse is caring for a client in the immediate postoperative period following an exploratory laparotomy after sustaining a gunshot wound to the abdomen. Which assessment finding is most important for the nurse to report to the health care provider? 1. Cold and clammy skin [41%] 2. Oxygen saturation of 92% [11%] 3. Sinus tachycardia of 108/min [16%] 4. Urine output of 0.6 mL/kg/hr [31%]

Hypovolemic (hemorrhagic) shock may occur after abdominal trauma or surgery as mesenteric edema resolves and previously compressed sites of bleeding reopen. The shock continuum is staged in severity from initial (I) to irreversible (IV). During the initial stage, there is inadequate oxygen to supply the demand at the cellular level and anaerobic metabolism develops. At this point, there may be no recognizable signs or symptoms. As shock progresses to the compensatory stage, sympathetic compensatory mechanisms are activated to maintain homeostasis (eg, oxygenation, cardiac output). Cold, clammy skin indicates failing compensatory mechanisms (ie, progressive stage), and immediate intervention is necessary to prevent irreversible shock and death (Option 1). (Option 2) Slightly low oxygen saturation may occur when there is inadequate oxygen supply and increased metabolic demand. It is not the most important finding to report. (Option 3) Sinus tachycardia is part of the compensatory response to maintain cardiac output and oxygen demand. It is not the most important finding to report. (Option 4) As shock continues, the kidneys decrease filtration and increase reabsorption to maintain blood pressure, eventually resulting in decreased urinary output. Normal urine output is 0.5-1 mL/kg/hr or >30 mL/hr.

The charge nurse is reviewing events that staff nurses experienced during the shift. Which events require an incident/occurrence report to be completed? Select all that apply. 1. Client determined brain dead was taken off life support 2. Client with alcohol intoxication physically assaulted a nurse 3. Serum troponin level was prescribed but never obtained 4. Staff nurse did not present for work and did not notify management 5. Visitor fell and refused care in the emergency department

Incident/occurrence reports are used in a health facility to document events that pose unanticipated actual or potential risk to the health or safety of a client, visitor, or employee. Incident/occurrence reporting is a method of quality improvement and should not be considered punitive in nature or be documented in the health record. Examples of events requiring reporting include: Assault and injury Physical, verbal, or sexual assault occurring in a health facility (Option 2) Client falls, with or without injury Staff and visitor falls, regardless of acceptance or refusal of treatment (Option 5) Treatment and intervention Failure to obtain or intervene upon the results of diagnostic procedures (Option 3) Inadequate or delayed diagnosis and monitoring Delay, omission, or incorrect performance or administration of prescribed therapies and medications Hospital equipment failure (Option 1) Withdrawal of life support in clients deemed brain dead is an expected and clinically justified course of care, and should be documented in the health record. (Option 4) Incident/occurrence reports are used to document clinical health and safety issues; managerial issues (eg, tardy or absent staff) should be documented in the employee's record.

A client is receiving IV sodium bicarbonate for acute metabolic acidosis. Which of these laboratory values would best indicate that the sodium bicarbonate has been effective? 1. Serum pH 7.32, HCO3- 26 mEq/L (26 mmol/L), potassium 4.9 mEq/L (4.9 mmol/L) [7%] 2. Serum pH 7.34, HCO3- 21 mEq/L (21 mmol/L), potassium 5.1 mEq/L (5.1 mmol/L) [6%] 3. Serum pH 7.39, HCO3- 24 mEq/L (24 mmol/L), potassium 3.8 mEq/L (3.8 mmol/L) [78%] 4. Serum pH 7.41, HCO3- 18 mEq/L (18 mmol/L), potassium 4.3 mEq/L (4.3 mmol/L) [6%]

Metabolic acidosis is due to an increase in the production or retention of acid (eg, lactic acidosis, ketoacidosis, renal failure) or the depletion of bicarbonate (HCO3-) via the kidneys or gastrointestinal tract. In metabolic acidosis, there is a decrease in pH (<7.35) and HCO3- (<22 mEq [22 mmol/L]). Acidosis damages cells, causing them to release intracellular contents (eg, potassium). Hyperkalemia (potassium >5.0 mEq/L [5 mmol/L]) frequently occurs with acidosis, putting the client at risk for cardiac arrhythmias. Depending on the cause and severity of acidosis, the client can exhibit altered mental status and tachypnea. Management focuses on treating the underlying cause and administering IV sodium bicarbonate to correct the imbalance. Arterial blood gas pH 7.39, HCO3- 24 mEq/L (24 mmol/L), and serum potassium 3.8 mEq/L (3.8 mmol/L) are within normal limits, indicating the sodium bicarbonate has effectively corrected acidosis. (Options 1, 2, and 4) These laboratory values are not within normal limits and do not indicate that the sodium bicarbonate has effectively corrected acidosis.

The health care provider (HCP) prescribes naproxen for a client who has degenerative joint disease. What instructions regarding this drug does the nurse include in the client's discharge plan? Select all that apply. 1. Avoid driving while taking this medicine 2. Change positions slowly 3. Discontinue immediately if suicidal thoughts occur 4. Notify the HCP of tarry stools 5. Take the medicine with food

Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) commonly prescribed to decrease joint pain and inflammation. All NSAIDs (eg, indomethacin, ibuprofen) are associated with the following: Gastrointestinal (GI) toxicity - symptoms of GI bleeding such as black tarry stools should be reported. Gastrointestinal upset (eg, dyspepsia, pain) can be reduced if the medicine is taken with food. Kidney injury - long-term use is associated with kidney injury Hypertension and heart failure - NSAIDs can cause fluid retention, which can exacerbate conditions such as heart failure, cirrhosis/ascites, and hypertension Bleeding risk - clients should notify the HCP if taking concurrently with aspirin, other NSAIDs, or anticoagulant or antiplatelet drugs as they can increase the risk of GI bleeding. (Option 1) Clients should not drive when taking sedating medications (eg, antihistamines, benzodiazepines). However, sedation is not associated with NSAID use. (Option 2) Orthostatic hypotension is common with blood pressure medications (eg, ACE inhibitors, alpha blockers) but not with NSAIDs. (Option 3) Suicidal thoughts are commonly associated with selective serotonin reuptake inhibitors (antidepressants) and varenicline (Chantix), a smoking cessation medication.

The nurse is caring for a baby born at 30 weeks gestation and diagnosed with necrotizing enterocolitis. Which nursing action should be implemented? 1. Encourage parents to increase skin-to-skin care [10%] 2. Measure abdominal girth daily [62%] 3. Measure rectal temperature every 3-4 hours [7%] 4. Position client on side and check diaper for stool [18%]

Necrotizing enterocolitis occurs predominantly in preterm infants secondary to gastrointestinal and immunologic immaturity. On initiation of enteral feeding, bacteria can be introduced into the bowel, where they can proliferate excessively due to compromised immune clearance. This results in inflammation and ischemic necrosis of the intestine. As the disease progresses, the bowel becomes congested and gangrenous with gas collections forming inside the bowel wall. Measuring the client's abdominal girth daily is an important nursing intervention to note any worsening intestinal gas-associated swelling. Clients are made NPO and receive nasogastric suction to decompress the stomach and intestines. Parenteral hydration and nutrition and IV antibiotics are given. (Option 1) Skin-to-skin care (kangaroo care) promotes bonding with a healthy newborn. It is allowed in some instances for premature infants depending on the condition and week of gestation. Skin-to-skin care should be avoided in infants who are not stable as it may cause additional stress. (Option 3) Taking a client's temperature every 3-4 hours is important; however, rectal temperatures should be avoided due to the risk of perforation of the gangrenous, friable colon. (Option 4) To avoid pressure on the abdomen and facilitate observation for a distended abdomen, clients are placed supine and undiapered.

The nurse is caring for a postoperative client who has D5W/0.45% normal saline with 10 mEq potassium chloride infusing through a peripheral IV catheter. What are appropriate reasons for the nurse to change the site? Select all that apply. 1. Area around the insertion site feels cool to the touch 2. Client reports mild arm discomfort since the infusion was started 3. Edema is observed on the dependent side of the involved arm 4. Intraoperative peripheral IV catheter is placed in the left antecubital region 5. Serous fluid leaks from the site despite secure connections

Peripheral IV (PIV) catheter sites should be changed usually no more frequently than every 72-96 hours unless signs of complications develop. Signs of phlebitis include erythema, edema, warmth, pain, and palpable venous cord. Manifestations of infiltration include edema and coolness to the touch around the insertion site (Option 1). The nurse should also monitor for edema related to infiltration under the involved limb. Infiltrated fluid may leak into loose skin, causing edema in dependent areas without obvious signs of infiltration at the PIV site, particularly in the elderly (Option 3). If a PIV site is leaking fluid, the tubing and catheter connections should be assessed. If all connections are intact, possible problems include infiltration/extravasation, a thrombus at the catheter tip, or damage to the catheter; all of these issues require a site change (Option 5). (Option 2) Potassium is a known irritant to veins. Discomfort is not a sign of infiltration, although the site should be regularly monitored for complications. (Option 4) Locations where flexion occurs (eg, antecubital region) are generally avoided; however, these sites may be required for certain medications or situations. Unless a problem develops, PIV sites are not changed based solely on location.

A client with a 20-year history of schizophrenia is hospitalized. The client appears visibly upset, approaches the nurse, and says in a shaky voice, "I can't find my headband. I can't find my headband. The oil is going to leak out of the crack in my head." What is the best response by the nurse? 1. "How long has the oil been leaking from your head?" [5%] 2. "Let's go back to your room and look for your headband together." [58%] 3. "There is no oil coming out of your head." [32%] 4. "You are going to miss breakfast if you do not go into the dining room." [3%]

The client, while delusional, is exhibiting signs of anxiety. The priority action for the nurse is to intervene in a manner that will assist in reducing the client's unease. The headband is part of the client's delusional system; it is highly likely that the client will continue to be apprehensive until the headband or substitute is found. Offering to help the client look for the headband conveys a sense of caring and helps establish a trusting relationship. Once the client has calmed down, the nurse will minimize any conversation about the "crack" and the "oil" and can direct the client to reality-oriented activities. Delusions are fixed, false beliefs that are accepted by the client as real and cannot be changed by logic, reason, or persuasion. Categories of delusions include the following: Persecutory - client thinks others are "out to get me" Ideas of reference - common events refer specifically to the client Grandiose - client has the perception of special importance or powers that are not realistic Somatic - false ideas about bodily functioning Nursing interventions include the following: Not arguing or challenging the belief Reinforcing reality by talking about and encouraging the client to participate in real events. The nurse should not delve into or have long conversations about the delusional belief system.

The nurse is caring for an infant with suspected meningitis and preparing to assist with a lumbar puncture. What is the appropriate nursing intervention? 1. Administer oxygen via nasal cannula for client comfort and safety [2%] 2. Clean area with povidone iodine in a circular motion moving outward [10%] 3. Hold the child with the head and knees tucked in and the back rounded out [77%] 4. Monitor and record vital signs every 15 minutes throughout the procedure [9%]

The optimal position for access during a lumbar puncture is to have the client's head and knees tucked in and the back rounded out. This provides the most room for the health care provider (HCP) to perform the procedure and allows for a good hold to keep the client still. A lumbar puncture is a sensitive procedure, and it is important to keep the child from moving during needle insertion. (Option 1) Unless the client has improper air exchange, oxygen administration is not needed. The nasal cannula will most likely bother the child and lead to unnecessary movement during needle placement. (Option 2) The HCP performing the lumbar puncture will feel the spine for correct needle placement and then sterilize and prepare the chosen area for needle insertion. (Option 4) Unless the client is unstable, there is no need to record vital signs every 15 minutes. The client should be awake and alert, and the procedure should be fairly short in duration.

A client with primary hypothyroidism has been taking levothyroxine for a year. Laboratory results today show high levels of TSH. Which statement by the nurse to the client is appropriate? 1. "A new prescription will likely be issued for a decreased dose of levothyroxine." [48%] 2. "Dosages of levothyroxine may need to be increased to improve TSH levels." [42%] 3. "Levothyroxine should be held, and the TSH levels will be reassessed in 3 months." [4%] 4. "Start taking your levothyroxine with dietary fiber or calcium to increase its effectiveness." [4%]

Thyroid-stimulating hormone (TSH) is released from the pituitary gland to stimulate the thyroid to secrete hormones (T3, T4). When sufficient thyroid hormone is circulating, negative feedback causes a normally functioning pituitary to slow or stop the release of TSH. In primary hypothyroidism, the thyroid is unable to synthesize enough T3 or T4, slowing the metabolic rate. In response to low circulating thyroid hormones, the pituitary continues to release TSH, resulting in high TSH levels. Levothyroxine (Synthroid), a thyroid hormone replacement drug, is commonly used to treat hypothyroidism. Levothyroxine dosing is adjusted to regulate circulating thyroid hormone levels; this creates a euthyroid (normal) state and TSH levels are decreased (Option 2). (Options 1 and 3) Decreasing the dose or discontinuing levothyroxine would lead to increased TSH and worsening hypothyroidism as the amount of circulating thyroid hormone decreases. (Option 4) Levothyroxine should be taken on a consistent morning schedule, at least 30 minutes before a meal. Foods containing certain ingredients (eg, walnuts, soy products, dietary fiber, calcium) can decrease drug absorption.

The nurse is reviewing teaching with the parents of a child who has tinea capitis (ringworm of the scalp) and is newly prescribed griseofulvin oral suspension and 1% selenium sulfide shampoo. Which statement by the child's parent requires the nurse to intervene? 1. "I will discontinue the griseofulvin once the ringworm stops itching and the scales go away." [57%] 2. "I will give the griseofulvin suspension to my child after consumption of high-fat food, like ice cream." [29%] 3. "I will monitor my child for increased sensitivity to sunlight while taking griseofulvin." [3%] 4. "I will wash my child's scalp a few times per week with the medicated shampoo." [9%]

Tinea capitis (ringworm of the scalp) is a contagious fungal infection that lives on the surface of the scalp, resulting in scaly, pruritic, erythematous, circular patches with hair loss. The infection is transmitted via direct contact with infected persons, pets, or objects (eg, hairbrushes, bedding, towels, hats). Treatment may include 1% selenium sulfide shampoo applied several times each week in combination with an antifungal medication (eg, griseofulvin oral suspension) that the client must take for several weeks to months. Keratin-producing cells absorb griseofulvin, causing resistance to the fungus; because the fungus requires keratin (protein in hair and skin cells) to live and grow, it is not able to reproduce. To ensure that infected keratin is shed completely, treatment with griseofulvin should not be discontinued early, even if symptoms (eg, itching, scaling) decrease (Option 1). (Option 2) The client will best absorb griseofulvin (ie, suspension, microsized tablets) when taken after/with high-fat foods (eg, ice cream). (Option 3) Photosensitivity is a common side effect of griseofulvin treatment, and the client should avoid prolonged exposure to the sun and use sunscreen. (Option 4) The client should apply medicated shampoo (eg, 1% selenium sulfide) to the scalp a few times each week.

The nurse is reinforcing instructions to a client at 34 weeks gestation who is preparing to travel by airplane. Which of the following instructions are appropriate? Select all that apply. 1. Avoid getting up during the flight unless you need the restroom 2. Carry a copy of your most up-to-date prenatal record 3. Increase fluid intake before and during the flight 4. Secure the lap belt below the abdomen and across your hips when seated 5. Wear compression hose and loose-fitting clothing

Travel during pregnancy requires special modifications and precautions to ensure client safety and reduce the potential for injury and pregnancy complications. Clients should get their health care provider's approval prior to traveling long distances. Domestic air travel is usually allowed for healthy clients at <36 weeks gestation. When reinforcing education about travel safety, the nurse should instruct the client to: carry an updated copy of the prenatal record in case emergency medical care is necessary during travel (Option 2). increase fluid intake to prevent dehydration and reduce the risk of thrombus formation or preterm contractions (Option 3). secure the lap belt under the gravid abdomen and across the hips and, if available, place shoulder belts lateral to the uterus and between the breasts to prevent complications from abdominal trauma (eg, placental abruption) (Option 4). wear compression stockings and unrestrictive clothing to improve venous return and decrease the risk of thrombus formation (Option 5). avoid traveling to Zika- or malaria-prevalent areas and remote areas with poor medical care or lack of sanitation. (Option 1) Pregnancy is a hypercoagulable state that augments the risk of thrombus formation. The nurse should encourage pregnant clients who embark on long travel to walk every 1-2 hours to decrease the risk of thrombus formation.