A nurse is caring for an 8-year-old child who is experiencing dry skin due to radiation therapy. Which of the following actions should the nurse suggest?
Remove the skin markings following radiation.
Apply lotions liberally to the skin.
Wear protective clothing when outside.
Cleanse skin with an antibacterial cleanser.
The Correct Answer is C
A. Remove the skin markings following radiation: Skin markings should not be removed during radiation therapy, as they are necessary for accurate targeting of radiation. Removing them can interfere with treatment accuracy and is not recommended.
B. Apply lotions liberally to the skin: While moisturizing can help with dryness, during radiation therapy, the nurse should recommend only mild, non-irritating, fragrance-free lotions approved by the radiation team. Applying products liberally or unapproved lotions can interfere with radiation dosing.
C. Wear protective clothing when outside: Radiation can make the skin more sensitive to sunlight. Wearing protective clothing and using sun protection helps prevent additional irritation, burns, or damage to already vulnerable skin. This is an appropriate measure to manage skin integrity.
D. Cleanse skin with an antibacterial cleanser: Antibacterial or harsh cleansers can irritate the sensitive skin of a child undergoing radiation therapy. Gentle, mild, fragrance-free soap and lukewarm water are preferred to maintain skin integrity without causing further damage.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. "I should expect my tears to turn a red color after using the eye drops.": Timolol does not cause red discoloration of tears. Redness of the eye may indicate irritation, allergy, or another adverse effect, so the client should report persistent redness rather than expect it as normal.
B. "I will put pressure on the corner of my eye after using the eye drops.": Applying gentle pressure to the nasolacrimal duct (inner corner of the eye) after instilling timolol reduces systemic absorption and potential systemic side effects, such as bradycardia or hypotension. This technique demonstrates proper administration and understanding of safety precautions.
C. "The drops should be placed in the center of my eye.": Eye drops should be instilled into the lower conjunctival sac, not directly onto the center of the cornea, to reduce irritation and maximize absorption. Placing drops on the cornea can cause discomfort and reduce effectiveness.
D. "These drops will improve my cloudy vision.": Timolol lowers intraocular pressure but does not restore vision or improve cloudiness caused by glaucoma. The goal of therapy is to prevent progression of vision loss, not to reverse existing damage.
Correct Answer is D
Explanation
A. Heart rate 98/min: A heart rate of 98 beats per minute is within normal limits (60–100/min) for adults. While it is at the upper end of normal, it does not typically require urgent reporting or intervention.
B. Widened P wave: A widened P wave may indicate atrial enlargement or conduction delay, which is important to note, but it is not immediately life-threatening. It should be documented and monitored, but it does not necessitate urgent notification.
C. 2 PVCs/min: Occasional premature ventricular contractions (PVCs) can occur in healthy individuals or as a response to stress, caffeine, or electrolyte imbalances. Two PVCs per minute is usually not critical unless associated with symptoms or patterns like couplets or runs of ventricular tachycardia.
D. S-T segment elevations: ST-segment elevation is a significant finding that can indicate acute myocardial injury or infarction. This is a medical emergency requiring immediate notification of the provider for rapid assessment, intervention, and potential reperfusion therapy.
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