A client arrives at the health care clinic and tells the nurse that she was just bitten by a tick and would like to be tested for Lyme disease.
Which nursing action is appropriate?

Inform the client that she will need to bring the tick for testing.

Inform the client that the tick is needed to perform a test.

Refer the client for a blood test immediately.

Ask the client about the size and color of the tick.

Answer and Explanation

The Correct Answer is C

Choice A rationale

Informing the client that she will need to bring the tick for testing is not necessary. While having the tick can help identify the species and potential risk, it is not required for testing for Lyme disease. The diagnosis can be made based on clinical symptoms and blood tests.

Choice B rationale

Informing the client that the tick is needed to perform a test is incorrect. The presence of the tick is not required for testing for Lyme disease. Blood tests can detect antibodies to the bacteria that cause Lyme disease, even if the tick is not available.

Choice C rationale

Referring the client for a blood test immediately is the appropriate action. Early testing can help diagnose Lyme disease and initiate treatment promptly. Blood tests can detect antibodies to Borrelia burgdorferi, the bacteria that cause Lyme disease, and help confirm the diagnosis.

Choice D rationale

Asking the client about the size and color of the tick is not the most appropriate action. While this information can provide some context, it does not directly contribute to the diagnosis of Lyme disease. The priority is to refer the client for a blood test to confirm the presence of the infection.

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Correct Answer is B

Explanation

Choice A rationale

Rephrasing statements the client does not hear is helpful but not the priority action. The priority is to determine if the client uses hearing aids to ensure they can hear instructions and communication effectively.

Choice B rationale

Determining if the client uses hearing aids is the priority action. Ensuring the client has and uses their hearing aids can significantly improve communication and care.

Choice C rationale

Speaking using the usual tone of voice and directly in front of the client is important but secondary to ensuring the client has their hearing aids.

Choice D rationale

Using hand gestures to communicate can be helpful but is not the priority action. The primary focus should be on ensuring the client has their hearing aids for optimal hearing.

A. Avoid bearing down. B. Avoid sudden movements. C. Increase sodium intake. D. Increase caffeine intake.

Correct Answer is B

Explanation

Choice A rationale

Avoiding bearing down is important for patients with certain conditions, but not specifically for Ménière’s disease.

Choice B rationale

Patients with Ménière’s disease should avoid sudden movements to prevent exacerbating vertigo and balance issues.

Choice C rationale

Increasing sodium intake can worsen fluid retention and symptoms of Ménière’s disease.

Choice D rationale

Increasing caffeine intake can exacerbate symptoms of Ménière’s disease, including tinnitus and vertigo.

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A client arrives at the health care clinic and tells the nurse that she was just bitten by a tick and would like to be tested for Lyme disease. Which nursing action is appropriate?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is B

Explanation

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A client arrives at the health care clinic and tells the nurse that she was just bitten by a tick and would like to be tested for Lyme disease.
Which nursing action is appropriate?