The school nurse is preparing a presentation for elementary school teachers to inform them about when a child should be referred to the school clinic for further follow-up. The teachers should be instructed to report which situation(s) to the school nurse? Select all that apply.

Shaking that changes the child's handwriting legibility.

Thirst and frequent requests for bathroom breaks.

Refusal to complete written homework assignments.

Bruises on both knees after the weekend.

Sunburn with blisters on the face, arms, and hands.

Answer and Explanation

Correct Answer : A,B,E

Choice A reason: Shaking that affects a child's handwriting could indicate a neurological issue or other medical conditions that require immediate attention. It's essential for teachers to report such observations to the school nurse for proper assessment and intervention.

Choice B reason: Excessive thirst and frequent urination can be signs of diabetes, especially in children. Early detection and management are crucial for the child's health, making it important for teachers to report these symptoms.

Choice C reason: While refusal to complete homework could be related to behavioral or social issues, it is not typically a medical concern that requires the school nurse's intervention unless accompanied by other signs of distress or health problems.

Choice D reason: Bruises could be common in children due to their active nature, especially after a weekend. However, unless there is a pattern or other concerning signs of abuse or a medical condition, bruises alone may not necessitate a referral to the school nurse.

Choice E reason: Sunburn with blisters is a sign of a second-degree burn, which can be serious, especially in children. It is important for teachers to report this to the school nurse so that the child can receive proper care and parents can be advised on treatment and prevention.

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Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"A"},"E":{"answers":"A"}}

Explanation

Choice A reason: No understanding.

While lifestyle changes can significantly reduce the risk of developing type 2 diabetes, they do not guarantee prevention. The client’s family history and current prediabetic fasting blood glucose level (122 mg/dL) indicate an increased risk. It’s important to understand that while risk can be minimized, it cannot be completely eliminated12.

Choice B reason:
People with diabetes or prediabetes can still consume sugar, but it should be in moderation and as part of a balanced diet. The DASH diet discussed with the client emphasizes portion control and a reduction in sugar intake, not complete elimination.

Choice C reason: No understanding

A single fasting blood glucose measurement below 100 mg/dL does not mean the client can revert to previous eating habits. Ongoing maintenance of a healthy diet and lifestyle is necessary to manage blood glucose levels and reduce the risk of diabetes.

Choice D reason: Understanding.

Lifestyle changes such as adopting the DASH diet and increasing physical activity can help manage weight, improve cholesterol levels, and lower the risk of chronic conditions like hypertension, cardiovascular disease, and type 2 diabetes.

Choice E reason: Understanding.

Increased thirst and urination are symptoms of high blood sugar levels. If the client experiences these symptoms, it would be prudent to check blood glucose levels to manage and monitor for diabetes.

A. Apply sequential compression stockings when in bed. B. Maintain strict bedrest for 12 hours after surgery. C. Provide chilled beverages. D. Change position frequently. E. Encourage coughing and deep breathing. F. Observe for signs and symptoms of dumping syndrome. G. Keep client NPO H. Maintain head at 45-degree angle.

Correct Answer is ["A","D","E","F","H"]

Explanation

Choice A reason: Applying sequential compression stockings when in bed is a recommended postoperative intervention for bariatric surgery patients. It helps prevent deep vein thrombosis (DVT) by promoting venous return and reducing venous stasis, which is particularly important in patients with obesity due to their increased risk for DVT.
Choice B reason: Maintaining strict bedrest for 12 hours after surgery is not typically recommended as it can increase the risk of complications such as DVT and pulmonary embolism. Early mobilization is generally encouraged to promote circulation and respiratory function.
Choice C reason: Providing chilled beverages is not a specific nursing intervention indicated in the immediate postoperative period for bariatric surgery patients. Fluid intake should be carefully monitored and regulated, but the temperature of the beverages is not a primary concern.
Choice D reason: Changing position frequently is an important postoperative intervention to prevent complications such as pressure ulcers and to promote lung expansion, especially in patients with obesity who are at higher risk for these issues.
Choice E reason: Encouraging coughing and deep breathing is essential after bariatric surgery to help clear the airways, prevent atelectasis, and improve oxygenation. This is particularly important for this patient who has a history of sleep apnea and reported diminished breath sounds postoperatively.
Choice F reason: Observing for signs and symptoms of dumping syndrome is relevant for bariatric surgery patients, as this syndrome can occur when food moves too quickly from the stomach to the small intestine. However, this is more of a long-term concern rather than an immediate postoperative intervention.
Choice G reason: Keeping the client NPO (nothing by mouth) is a common immediate postoperative order, but as the patient progresses, they will be started on a liquid diet and advanced as tolerated. Therefore, it is not a nursing intervention that would be indicated indefinitely.
Choice H reason: Maintaining the head at a 45-degree angle can help improve respiratory function by reducing pressure on the diaphragm, which is especially beneficial for patients with obesity and a history of sleep apnea, as in this case.

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The school nurse is preparing a presentation for elementary school teachers to inform them about when a child should be referred to the school clinic for further follow-up. The teachers should be instructed to report which situation(s) to the school nurse? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Patient Data Exhibits Review H and P, nurse's note, and laboratory results. Click to mark whether the client statement indicates understanding no understanding of the education given.

Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"A"},"E":{"answers":"A"}}

Explanation

Patient Data Exhibits The nurse reviews new data. Which 5 nursing interventions are indicated for this client?

Correct Answer is ["A","D","E","F","H"]

Explanation

Patient Data: Exhibits Review H and P and laboratory results. Based on the laboratory data, the client has dropdown related to dropdown

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The school nurse is preparing a presentation for elementary school teachers to inform them about when a child should be referred to the school clinic for further follow-up. The teachers should be instructed to report which situation(s) to the school nurse? Select all that apply.

The home care nurse provided self-care instructions for a client with chronic venous insufficiency caused by deep vein thrombosis. What instruction(s) should the nurse include in the client's discharge teaching plan? Select all that apply.