The nurse observes an 18-month-old toddler keeping a bottle of milk in the mouth throughout the history-taking and assessment process during a well-child visit.

The mother confirms that the child has a bottle available most of the day and remarks that it makes a great pacifier.

Which response should the nurse provide?

A bottle is generally much better than using a pacifier.

The bottle will assist in preventing thumb sucking.

Prolonged bottle use can increase the risk for cavities.

Using milk rather than juice helps to avoid tooth decay.

Answer and Explanation

The Correct Answer is C

Choice A rationale:

A bottle is generally much better than using a pacifier. This statement is not accurate. Prolonged bottle use, especially with sugary liquids like milk, can have adverse effects on a child's dental health. It can lead to an increased risk of cavities, similar to prolonged pacifier use.

Choice B rationale:

The bottle will assist in preventing thumb sucking. This statement is incorrect. While a bottle may provide comfort to a child, it does not prevent thumb sucking. Thumb sucking is a separate behavior that may also have dental implications if it persists beyond a certain age.

Choice C rationale:

Prolonged bottle use can increase the risk for cavities. This response is correct. Prolonged bottle use, especially with milk or sugary beverages, can expose the child's teeth to prolonged contact with sugars, increasing the risk of cavities. It's important for the nurse to educate the mother about the potential dental risks associated with extended bottle use.

Choice D rationale:

Using milk rather than juice helps to avoid tooth decay. While milk is generally considered a healthier choice than juice, the key issue in this scenario is the prolonged use of the bottle, regardless of its content. Prolonged bottle use with any liquid, including milk, can still increase the risk of cavities.

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Free Nursing Study Resources

Correct Answer is ["B","D"]

Explanation

Choice A rationale: Orange juice contains pulp and is not considered a clear liquid. A clear liquid diet is restricted to fat-free liquids and those that are transparent at room temperature.

Choice B rationale: Apple juice is a transparent liquid that remains liquid at room temperature. It provides carbohydrates and fluid without leaving residue in the gastrointestinal tract, fitting the clear liquid requirement.

Choice C rationale: Hot chocolate contains dairy or cocoa solids, making it an opaque liquid. It is excluded from a clear liquid diet and also contains caffeine, which Mormons typically avoid.

Choice D rationale: Chicken broth is a clear, fat-free liquid that provides electrolytes and hydration. It is an essential component of a clear liquid diet and does not violate any Mormon dietary restrictions.

Choice E rationale: Black coffee is a caffeinated beverage. The Word of Wisdom in Mormon belief prohibits the consumption of "hot drinks," specifically interpreted as coffee and tea, regardless of the diet type.

A. Reassure the client that someone will check on him hourly. B. Place fresh water and a glass within reach on the bedside table. C. Ensure that the call bell is easily accessible to the client. D. Offer the client an evening snack before providing oral care.

Correct Answer is C

Explanation

The correct answer is choice C: Ensure that the call bell is easily accessible to the client.

Choice C rationale: Ensuring that the call bell is easily accessible empowers the client to promptly request assistance if needed during the night. This promotes safety and reduces anxiety, as the client can quickly contact the nurse if they experience an urgent need to use the restroom or require any other assistance during the night.

Choice A rationale: Reassuring the client that someone will check on him hourly may provide some comfort, but it does not directly address the client's issue of urinary frequency. Ensuring easy access to the call bell is a more targeted approach to managing the client's needs.

Choice B rationale: Placing fresh water and a glass within reach on the bedside table is a good practice to maintain hydration, but it does not directly address the client's urinary frequency issue.

Choice D rationale: Offering an evening snack and oral care is essential for the client's overall well-being, but it is not directly related to managing the client's urinary frequency at night. The primary focus should be on ensuring that the client can access assistance quickly when needed.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse requests a meal tray for a client who follows Mormon beliefs and who is on a clear liquid diet following abdominal surgery. Which menu item(s) should the nurse request for this client? (Select all that apply).

Correct Answer is ["B","D"]

Explanation

When caring for an older male client with urinary frequency, which measure is most important for the nurse to implement to help the client prepare to go to bed for the night?

Correct Answer is C

Explanation

Which is the best approach for the nurse to use when interviewing a client about intimate partner violence?

After receiving a change of shift report for clients on a medical surgical unit, which task should the nurse assign to an unlicensed assistive personnel (UAP)?

A client asks a nurse about the differences between major depressive disorder (MDD) and dysthymia. Which of the following responses by the nurse is accurate?

A nurse is teaching a client with hypertension about antihypertensive drugs. Which of the following statements by the client indicates an understanding of the teaching?

The unlicensed assistive personnel (UAP) tells the practical nurse (PN) that a male client is angry because the night shift took over 2 hours to bring him the pain medication, he had to request three times. Which action should the PN implement first?

When performing a focused gastrointestinal system assessment, the practical nurse (PN) asks a male client when his last bowel movement occurred. The client answers, "Three days ago." Which action should the PN implement first?

The nurse is caring for a client with the sexually transmitted infection (STI) syphilis. The client reports having unprotected sex. Which response should the nurse provide?

A nurse is providing education to a client prescribed an antidepressant for their phobia. Which statement by the client indicates a need for further teaching?