A nurse is providing discharge teaching to a client who has an impaired immune system due to chemotherapy. Which of the following information should the nurse include in the teaching?

"Wash your toothbrush in the dishwasher once each month."

"Change your pet's litter box daily."

"Change the water in your drinking glass every 4 hours."

"Wash your perineal area two times each day with antimicrobial soap."

Answer and Explanation

The Correct Answer is C

A. The nurse should recommend that the client avoid using a toothbrush that is not regularly disinfected. However, washing the toothbrush in the dishwasher may not be sufficient. The client should replace the toothbrush regularly and disinfect it appropriately.

B. Changing the pet's litter box daily is not safe for clients with an impaired immune system. The nurse should advise the client to avoid cleaning the litter box or, if necessary, to wear gloves and a mask while performing the task, and ask someone else to do it if possible.

C. Changing the water in the drinking glass every 4 hours is an important infection control measure for clients with compromised immune systems. Stagnant water can promote bacterial growth, which poses an increased risk for infection in immunocompromised clients.

D. Washing the perineal area two times each day with antimicrobial soap is unnecessary and may cause irritation or disrupt the natural flora of the skin. The nurse should recommend gentle cleansing with mild soap and water instead. Overuse of antimicrobial products can lead to skin damage or resistance.

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Correct Answer is B

Explanation

A. While monitoring the client's temperature is important, it is not the highest priority immediately following sedation.

B. The gag reflex is a critical assessment after moderate sedation, especially following procedures like endoscopy, as it ensures that the client can protect their airway and swallow safely. If the gag reflex is not intact, there is a risk of aspiration or airway obstruction.

C. Warmth of extremities is an important sign of circulation, but it is not as critical as the gag reflex after a procedure involving sedation and airway manipulation.

D. Level of pain is important, but it is secondary to ensuring that the client’s airway is protected. Pain management can be addressed once the client's airway and safety are ensured.

A. Metabolic acidosis B. Respiratory acidosis C. Metabolic alkalosis D. Respiratory alkalosis

Correct Answer is C

Explanation

A. Metabolic acidosis is not typically associated with excessive ingestion of antacids. Antacids, especially those containing aluminum, calcium, or magnesium, are more likely to cause alkalosis, not acidosis.

B. Respiratory acidosis is caused by impaired gas exchange (e.g., in conditions like COPD or hypoventilation) and is unrelated to antacid ingestion.

C. Metabolic alkalosis is the correct answer. Excessive ingestion of antacids, particularly those containing sodium bicarbonate or calcium carbonate, can lead to an increase in bicarbonate levels, resulting in metabolic alkalosis. Symptoms can include confusion, muscle twitching, and respiratory depression.

D. Respiratory alkalosis is caused by hyperventilation, not antacid ingestion. It results from excessive loss of carbon dioxide, which is not associated with the use of antacids.

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A nurse is providing discharge teaching to a client who has an impaired immune system due to chemotherapy. Which of the following information should the nurse include in the teaching?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is postoperative following an endoscopy with moderate (conscious) sedation. Which of the following assessment findings is the nurse's priority?

Correct Answer is B

Explanation

A nurse in an emergency department is caring for a client who is receiving treatment for excessive ingestion of antacids. The nurse should identify that this client is at risk for which of the following acid-base imbalances?

Correct Answer is C

Explanation

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