A nurse is performing discharge teaching with a client who has leukemia. Which of the following client statements indicates an understanding of the teaching?

"I can change my cat's litter box every day."

"I will avoid blowing my nose when I feel congested."

"I can continue gardening in my yard."

"I will clean my toothbrush with an alcohol-based mouthwash."

Answer and Explanation

The Correct Answer is B

A. "I can change my cat's litter box every day.": Clients with leukemia are immunocompromised and at increased risk for infections such as toxoplasmosis from cat feces. They should avoid changing litter boxes or use protective measures like gloves and masks, so this statement indicates a misunderstanding of infection prevention.

B. "I will avoid blowing my nose when I feel congested.": Avoiding forceful nose blowing helps prevent mucosal trauma and bleeding, which is important for clients with leukemia who may have thrombocytopenia or fragile mucous membranes. This statement demonstrates an understanding of precautions to reduce injury and infection risk.

C. "I can continue gardening in my yard.": Gardening exposes the client to soilborne pathogens and bacteria, increasing the risk of infection. Clients with leukemia should avoid activities that involve soil contact unless using strict protective measures, so this statement indicates a lack of understanding.

D. "I will clean my toothbrush with an alcohol-based mouthwash.": Cleaning a toothbrush with mouthwash is not sufficient to prevent microbial contamination. Clients with leukemia should use a soft-bristled toothbrush and replace it regularly to minimize infection risk. This statement reflects incomplete understanding of oral care precautions.

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Correct Answer is B

Explanation

A. Seizure disorder: A seizure disorder does not directly affect the use of metformin. While some medications used to manage seizures may have interactions, metformin itself is not contraindicated in clients with a history of seizures, and it can generally be used safely with proper monitoring.

B. Renal insufficiency: Metformin is contraindicated in clients with renal insufficiency because impaired kidney function can lead to accumulation of the drug, increasing the risk of lactic acidosis, a rare but potentially life-threatening complication. Baseline and ongoing assessment of renal function, such as serum creatinine and estimated glomerular filtration rate (eGFR), is essential before starting therapy.

C. Polycystic ovary syndrome: Metformin is actually commonly used in clients with polycystic ovary syndrome to improve insulin sensitivity and support ovulation. This condition is not a contraindication, and metformin may provide therapeutic benefits beyond glucose control.

D. Gluten intolerance: Gluten intolerance has no impact on metformin use. Metformin does not contain gluten and does not interfere with gluten-related conditions, so it can be safely prescribed in clients with gluten intolerance.

A. High Fowler's B. Left lateral C. Standing D. Supine

Correct Answer is B

Explanation

A. High Fowler's: High Fowler’s position can assist with respiratory effort and comfort, but it does not specifically optimize cardiac output in a pregnant client. Upright positioning alone may not relieve pressure from the gravid uterus on major vessels.

B. Left lateral: Placing the client in the left lateral position relieves pressure of the uterus on the inferior vena cava and aorta, enhancing venous return to the heart and improving cardiac output. This position is especially important in clients with cardiac disease to reduce the risk of supine hypotensive syndrome and optimize maternal and fetal circulation.

C. Standing: Standing does not provide support for venous return and can increase the workload on the heart, potentially exacerbating cardiac compromise. It is not recommended for prolonged periods in clients with cardiac disease during pregnancy.

D. Supine: Supine positioning can compress the inferior vena cava and aorta, reducing venous return and cardiac output. This can lead to hypotension and decreased perfusion to both the mother and fetus, making it unsafe for pregnant clients with cardiac disease.

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A nurse is performing discharge teaching with a client who has leukemia. Which of the following client statements indicates an understanding of the teaching?

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