A nurse is collecting data from a client who has pernicious anemia.
The nurse should identify that which of the following findings increases the client's risk for injury?
Uses a firm-bristled toothbrush.
Prescribed vitamin B12 IM.
Prescribed epoetin IV.
Sleeps 8 to 10 hr per night.
The Correct Answer is A
Choice A rationale:
Using a firm-bristled toothbrush can increase the risk of gum injury or bleeding, especially in individuals with pernicious anemia who may have fragile gums due to vitamin B12 deficiency. This choice is correct because it identifies a risk factor for injury.
Choice B rationale:
Prescribing vitamin B12 intramuscularly (IM) is the appropriate treatment for pernicious anemia and does not increase the client's risk of injury. It is essential for addressing the underlying deficiency.
Choice C rationale:
Prescribing epoetin intravenously (IV) is used to stimulate the production of red blood cells and treat anemia, but it is not typically associated with an increased risk of injury. However, it should be administered as ordered by the healthcare provider.
Choice D rationale:
Sleeping 8 to 10 hours per night is beneficial for overall health and well-being. It does not increase the client's risk of injury. In fact, adequate sleep can help with tissue repair and overall recovery.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Allowing the patient to lift the CPM machine onto the bed is not a safe practice. Arthroscopic surgery may result in limited mobility and discomfort for the patient. Lifting heavy equipment could potentially strain the surgical site or lead to injury.
Choice B rationale:
Telling the patient that CPM will not hurt at all is not accurate. While CPM is a passive motion technique aimed at preventing joint stiffness, some discomfort or mild pain may be experienced, especially during the initial sessions. Managing the patient's pain is essential to ensure compliance with the CPM exercises.
Choice C rationale:
Suggesting that the patient does not need to do CPM exercises is incorrect. CPM exercises are often prescribed after joint surgery to prevent joint stiffness, improve circulation, and aid in recovery. Discouraging the patient from participating in these exercises would be detrimental to their postoperative outcome.
Choice D rationale:
Administering an opioid analgesic to the client 30 minutes before initiating CPM exercises is the correct choice. CPM exercises can be uncomfortable for some patients, especially in the initial stages, and providing adequate pain relief before starting the exercises promotes patient comfort and compliance. It helps ensure that the patient can perform the exercises effectively without undue pain, reducing the risk of complications and promoting a successful recovery.
Correct Answer is D
Explanation
Choice A rationale:
"This medication will darken the color of my eyes." This statement is not accurate. Timolol eye drops, which are commonly used to treat glaucoma, do not darken the color of the eyes. This statement indicates a misunderstanding of the medication's effects.
Choice B rationale:
"This medication will dilate my eyes." This statement is not accurate either. Timolol is a beta-blocker that works to reduce intraocular pressure by decreasing the production of aqueous humor in the eye. It does not dilate the eyes; in fact, it has the opposite effect.
Choice C rationale:
"I should take a zinc supplement while taking this medication." This statement is unrelated to the use of timolol eye drops for glaucoma and is not part of the standard treatment plan. There is no established connection between taking zinc supplements and using timolol for glaucoma management.
Choice D rationale:
"I should check my heart rate while taking this medication." This statement indicates an understanding of the teaching. Timolol is a beta-blocker that can lower heart rate and blood pressure. Clients using timolol eye drops should be advised to monitor their heart rate regularly and report any significant changes to their healthcare provider. This is important for safety and to ensure that the medication is not causing any adverse cardiovascular effects.
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