An adult client is admitted with AIDS and oral Candide albicans manifested by several painful mouth ulcers. The nurse delegates oral care to the unlicensed assistive personnel (UAP) and discusses how to assist the client. Which instruction should the nurse provide to the UAP?
Offer the client mouthwash for thorough cleansing after brushing teeth.
Assist with personal case, but leave oral care for the nurse to complete.
Provide a soft-bristled toothbrush for the client to use during oral care.
Wear sterile gloves when cleansing any areas of infected mucosa.
The Correct Answer is C
C. In the case of oral candidiasis, using a toothbrush with soft bristles is essential to prevent further irritation and damage to the already compromised oral mucosa.
A. Offering the client mouthwash for thorough cleansing after brushing teeth might not be appropriate. Many commercial mouthwashes contain alcohol, which can further irritate the oral mucosa and exacerbate the symptoms of oral candidiasis.
B. Assisting with personal care but leaving oral care for the nurse to complete is not the best option. Oral care is an essential aspect of hygiene, especially for someone with oral candidiasis.
D. Oral candidiasis is a fungal infection that is not typically transmitted through contact,
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
B Early signs of rheumatoid arthritis often manifest in the small joints of the hands and fingers. Common findings may include swelling, redness, warmth, and stiffness in these joints. Therefore, observing the client's fingers for any signs of inflammation or deformity can provide valuable clues for early detection of rheumatoid arthritis.
A Swollen lymph node may occur in certain types of arthritis, such as reactive arthritis but they are not typically a hallmark sign of rheumatoid arthritis.
C Rheumatoid nodules can develop in later stages of rheumatoid arthritis, but they are not typically present in the early stages of the disease.
D Rheumatoid arthritis is an autoimmune disease that can affect multiple organ systems, including the skin but characteristic skin lesions are not typically associated with the early stages of the condition.
Correct Answer is C
Explanation
C. Type I hypersensitivity reactions, also known as immediate hypersensitivity reactions, involve the production of IgE antibodies in response to an allergen. In this case, the bee sting likely triggered an IgE-mediated immune response, leading to the release of inflammatory mediators such as histamine. The client's symptoms of body rash, shortness of breath, tachycardia, and hypotension are characteristic of anaphylaxis, which is a severe and potentially life-threatening manifestation of Type I hypersensitivity reactions.
A.. Type II hypersensitivity reactions occur when the immune system targets antigens on the body's own cells, leading to cell destruction or dysfunction.
B. Autoimmune responses involve the immune system mistakenly attacking the body's own tissues and organs, leading to inflammation and tissue damage.
D. Cell-mediated hypersensitivity reactions involve the activation of T cells and the release of cytokines, resulting in inflammation and tissue damage. Examples include delayed-type hypersensitivity reactions such as contact dermatitis or tuberculin skin testing reactions.
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