A nurse is teaching a female client who has a new prescription for transdermal sumatriptan to treat migraine headaches. Which of the following instructions should the nurse include?

Choice A reason: The preschooler mispronounces words can be a sign of a speech sound disorder. While some mispronunciation is normal in early speech development, persistent difficulty with articulation may indicate a need for speech therapy to improve clarity and communication skills.

Choice B reason: The preschooler speaks in three-word sentences may indicate a delay in expressive language development. By preschool age, children typically use longer sentences and more complex language structures. Limited sentence length can suggest a need for further evaluation and intervention.

Choice C reason: The preschooler stutters when speaking can be a sign of a fluency disorder. Stuttering involves disruptions in the flow of speech, such as repetitions, prolongations, or blocks. Early intervention with speech therapy can help manage and reduce stuttering.

Choice D reason: The preschooler talks to himself when reading is generally not a concern. Self-talk can be a normal part of development and learning, as children often verbalize their thoughts and actions. It does not typically indicate a need for speech therapy.

Choice E reason: The preschooler speaks in a nasally tone can indicate a resonance disorder, which affects the quality of the voice. A nasally tone may result from structural issues or improper use of the vocal tract. Speech therapy can help address these issues and improve vocal quality.

Choice A reason: 0.9% sodium chloride, also known as normal saline, is not the best choice for interim fluid replacement when TPN is delayed. While it can maintain hydration and electrolyte balance, it does not provide the necessary calories that TPN supplies. TPN solutions are rich in dextrose, amino acids, and lipids, which are essential for patients who cannot receive nutrition through their gastrointestinal tract.

Choice B reason: Dextrose 5% in water (D5W) provides some calories but not enough to meet the nutritional needs of a patient who is dependent on TPN. D5W contains 5 grams of dextrose per 100 mL, providing 170 calories per liter. This is insufficient for patients who require high-calorie intake due to their inability to eat or absorb nutrients normally.

Choice C reason: Dextrose 10% in water (D10W) is the most appropriate choice for interim fluid replacement when TPN is delayed. D10W provides 10 grams of dextrose per 100 mL, offering 340 calories per liter. This higher concentration of dextrose helps to maintain the patient’s caloric intake and prevent hypoglycemia until the next TPN container is available.

Choice D reason: Lactated Ringer’s solution is primarily used for fluid and electrolyte replacement. It contains sodium, potassium, calcium, chloride, and lactate, but it does not provide the necessary calories that TPN supplies. Therefore, it is not suitable for maintaining the nutritional needs of a patient who is dependent on TPN.