Question 1 See full question
Several hours into a shift, a nurse on a very busy medical-surgical unit privately asks
the charge nurse to change her
... [Show More] assignment. She is frustrated because she has had to
devote so much time and energy to helping a newly licensed nurse provide discharge
teaching for clients with diabetes mellitus. The charge nurse should:
Correct response:
offer to assist with the discharge teaching needs.
Explanation:
Staff members need to know the charge nurse is a supportive leader who respects their
honesty and stands behind them. By offering to help with discharge teaching, the
charge nurse is actively engaging with her staff at a time of need. Changing all the
assignments on this extremely busy floor would be counterproductive. Insisting that the
staff member follow through with her assignment disrespects her request and genuine
need. Providing a float nurse could help, but there are no guarantees a float nurse is
available.
Remediation:
Discharge
Question 2 See full question
During chemotherapy, an oncology client has a nursing diagnosis of Impaired oral
mucous membrane related to decreased nutrition and immunosuppression secondary
to the cytotoxic effects of chemotherapy. Which nursing intervention is most likely to
decrease the pain of stomatitis
Correct response:
Providing a solution of viscous lidocaine for use as a mouth rinse
Explanation:
To decrease the pain of stomatitis, the nurse should provide a solution of hydrogen
viscous lidocaine for the client to use as a mouth rinse. (Commercially prepared
mouthwashes contain alcohol and may cause dryness and irritation of the oral mucosa.)
The nurse also may administer systemic analgesics as ordered. Stomatitis occurs 7 to
10 days after chemotherapy begins; thus, stopping chemotherapy wouldn't be helpful or
practical. Instead, the nurse should stay alert for this potential problem to ensure prompt
treatment. Monitoring platelet and leukocyte counts may help prevent bleeding and
infection but wouldn't decrease pain in this highly susceptible client. Checking for signs
and symptoms of stomatitis also wouldn't decrease the pain.
Remediation:
Impaired Oral Membrane
Question 3 See full question
A nurse has been caring for an adolescent client in a residential facility. The child has
been through a series of foster placements since infancy with no success in any
placement until the age of 7 when placed with a middle-aged single woman. The client
thrived there until the woman was killed in a car accident. The client attempted suicide
after her foster mother died in response to the loss and the child was placed in the
residential facility. The nurse has become close to this client and wants to help her
address her issues and move on with her life. Which comment to the manager
demonstrates that the nurse understands the client’s issues and is able to respond
appropriately to the client’s needs [Show Less]