A nurse is planning care for a toddler who has developed oral ulcers in response to chemotherapy.
Which of the following actions should the nurse include in the plan of care?
Schedule routine oral care every 8 hours.
Moisten the mucosa with lemon glycerin swabs.
Administer oral viscous lidocaine.
Cleanse the gums with saline-soaked gauze.
The Correct Answer is D
Cleanse the gums with saline-soaked gauze.
This can help keep the mouth moist and clean, which is important for preventing infection and promoting healing of oral ulcers caused by chemotherapy.

Choice A is wrong because routine oral care should be performed more frequently than every 8 hours.
Choice B is wrong because lemon glycerin swabs can dry out and irritate the mucosa.
Choice C is wrong because oral viscous lidocaine should not be used in children due to the risk of toxicity.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation

When a child ingests a toxic dose of acetylsalicylic acid, it can lead to salicylate toxicity, which can cause hyperpyrexia (high fever), among other symptoms such as vomiting, tinnitus, confusion, and dehydration. Hyperpyrexia is a serious complication that can lead to neurological damage and is a medical emergency that requires prompt intervention.
The nurse should monitor the child's temperature and administer antipyretic medications as necessary to reduce the fever.
Choice B is wrong because Polyuria, is not a common symptom of acute acetylsalicylic acid poisoning.
Salicylate toxicity can cause dehydration due to vomiting, which can lead to decreased urine output.
Choice C is wrong because Neck vein distention, is not typically associated with acetylsalicylic acid poisoning.
Neck vein distention is commonly seen in patients with heart failure, tension pneumothorax, or cardiac tamponade.
Choice D is wrong because Jaundice, is not a common symptom of acetylsalicylic acid poisoning. Jaundice is usually seen in liver diseases or hemolytic anemias.
Correct Answer is A
Explanation
The nurse should request verbal consent from the client for STI testing.
All 50 states and the District of Columbia explicitly allow minors to consent for their own STI services.
Choice B is wrong because it is not necessary to contact the client’s parents to obtain phone consent.
Choice C is wrong because it is not necessary to postpone the testing until the client’s parents are present.
Choice D is wrong because written consent is not required for STI testing.
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