A nurse is caring for a client who is receiving positive pressure mechanical ventilation. Which of the following interventions should the nurse implement to prevent complications? (Select all that apply)

Choice A reason: You sound overwhelmed. Let’s talk about this some more. This response acknowledges the mother’s feelings and opens the door for further discussion. However, it does not directly address her specific concerns about physical activities. While it is empathetic, it lacks the focus needed to explore her worries about her son’s participation in school activities.

Choice B reason: I agree. His well-being is the most important. This response validates the mother’s concern but may inadvertently reinforce her fears without providing a balanced perspective. It does not encourage a discussion about the benefits of physical activity for children with diabetes or how to manage his condition safely during such activities.

Choice C reason: Tell me more about how you are feeling about your son’s activities. This response is the most appropriate as it invites the mother to express her specific concerns and feelings. It shows empathy and a willingness to understand her perspective, which can lead to a more productive conversation about managing her son’s diabetes while allowing him to participate in physical activities.

Choice D reason: You might want to use tutors to home-school him. This response suggests an alternative that may not be necessary or beneficial. Home-schooling might isolate the child and prevent him from enjoying social interactions and physical activities that are important for his overall development. It does not address the mother’s concerns directly and may not be the best solution.

Choice A reason:

The statement “Rinse mouth 2 times per day with an alcohol-based mouthwash” is incorrect. Methotrexate can cause mouth sores and irritation, and using an alcohol-based mouthwash can exacerbate these symptoms. Instead, patients are often advised to use a non-alcoholic mouthwash or a saline rinse to help prevent and soothe mouth sores.

Choice B reason:

The statement “Take the medication with an NSAID” is incorrect. Methotrexate should not be taken with nonsteroidal anti-inflammatory drugs (NSAIDs) without medical supervision because this combination can increase the risk of severe side effects, including bone marrow suppression and gastrointestinal toxicity. Patients should always consult their healthcare provider before combining these medications.

Choice C reason:

The statement “Take an antiemetic 1 hour following administration” is not standard advice for methotrexate. While methotrexate can cause nausea, antiemetics are typically taken before or at the same time as the methotrexate dose to prevent nausea, not after. Patients should follow their healthcare provider’s instructions regarding the timing of antiemetics.

Choice D reason:

The statement “Drink 2 to 3 liters of water per day” is correct. Methotrexate can cause kidney damage, and staying well-hydrated helps to prevent this by promoting the excretion of the drug and reducing its concentration in the kidneys. Drinking plenty of fluids is an important part of managing methotrexate therapy safely.