When a client with cystic fibrosis is prescribed pancreatic enzymes, what is the best time for the nurse to administer them to the client?

Between meals.

Before meals.

During meals.

After meals.

Answer and Explanation

The Correct Answer is B

Choice A rationale:

Administering pancreatic enzymes between meals may not provide the necessary digestive support when food is introduced to the gastrointestinal tract. These enzymes are meant to aid in digestion, so administering them between meals might not be as effective as when taken in conjunction with food.

Choice B rationale:

Administering pancreatic enzymes before meals is the most appropriate time because it helps replace the missing enzymes in patients with cystic fibrosis. These enzymes aid in breaking down food and absorbing nutrients, compensating for the deficient pancreatic function. By giving the enzymes before meals, the body has the necessary support to digest the incoming food.

Choice C rationale:

While administering enzymes during meals might seem logical, it's actually less effective. The enzymes need time to mix with the ingested food before it enters the small intestine, where digestion primarily occurs.

Choice D rationale:

Administering pancreatic enzymes after meals wouldn't be as effective because the enzymes need to be present when food enters the stomach and begins the digestive process.

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Correct Answer is B

Explanation

Choice A rationale:

Planning for nurses to provide feedings is not necessary since this is not related to the nursing care plan and doesn't address the mother's concern.

Choice B rationale:

Reporting the finding to the health care provider is appropriate because vomiting after surgical repair of hypertrophic pyloric stenosis could indicate a potential complication or issue.

Choice C rationale:

Assuring the mother that vomiting after surgical repair is normal might not be accurate and could dismiss a potentially significant concern.

Choice D rationale:

Telling the mother it is all right to feel anxious doesn't address the vomiting concern directly and might not be the most pertinent response at this time.

A. Keep the cast covered with a light-weight blanket. B. Maintain increased humidity in the patient room. C. Use only the tips of the fingers when handling the cast. D. Monitor the capillary refill time in the toes on both feet.

Correct Answer is D

Explanation

Answer is d. Monitor the capillary refill time in the toes on both feet. This is crucial for assessing circulation and ensuring that the cast is not impairing blood flow, which is a priority in cast care.

Choice A rationale:

Ensuring the appropriate care for a wet plaster cast is essential to prevent complications such as impaired circulation, discomfort, or skin breakdown. Keeping the cast covered with a lightweight blanket, as suggested in option A, may seem like a logical step to protect it from external elements and maintain warmth. However, covering a wet cast can actually retain moisture, which can slow the drying process. Moisture retention within the cast can lead to prolonged drying times, increasing the risk of complications such as skin maceration or discomfort for the patient. Therefore, while the intention behind covering the cast is to provide comfort, it may inadvertently prolong the drying process and contribute to potential complications.

Choice B rationale:

Maintaining increased humidity in the patient room, as mentioned in option B, might appear beneficial to aid in the drying process of the plaster cast. However, while humidity can influence the drying time of the cast, excessive humidity can have adverse effects on the integrity of the cast. High humidity levels can prolong the drying process by inhibiting the evaporation of moisture from the cast material. Additionally, increased humidity can compromise the structural integrity of the cast, potentially leading to weaknesses or deformities. Therefore, while it's important to consider environmental factors in cast care, maintaining excessively high humidity levels may not be advisable and could contribute to complications in the drying and integrity of the cast.

Choice C rationale:

Option C suggests using only the tips of the fingers when handling the wet cast. While it's crucial to handle a wet cast with care to avoid causing damage or deformities, limiting handling to just the fingertips may not provide adequate support or control. Plaster casts can be fragile when wet, and improper handling techniques may lead to misshaping or weakening of the cast structure. Additionally, relying solely on the fingertips for handling may increase the risk of inadvertently applying uneven pressure or causing accidental damage to the cast material. Therefore, while the intention behind this option is to promote gentle handling, it may not provide sufficient support or control to ensure the integrity of the wet cast.

Choice D rationale:

Monitoring the capillary refill time in the toes on both feet, as indicated in option D, is the most appropriate action for the nurse to take in this scenario. Capillary refill time is a valuable indicator of peripheral circulation and tissue perfusion. By assessing the capillary refill time in the toes, the nurse can evaluate the adequacy of blood flow to the extremities and detect any potential impairment caused by the plaster hip spica cast. Prolonged capillary refill time may suggest compromised circulation, which can lead to serious complications such as ischemia or tissue necrosis if left unaddressed. Therefore, regular monitoring of capillary refill time is essential for early detection of circulation problems and timely intervention to ensure patient safety and optimal outcomes.

In conclusion, while each option may seem plausible at first glance, careful consideration of the potential implications reveals that monitoring capillary refill time in the toes on both feet is the most appropriate action for the nurse to take when caring for a patient with a wet plaster hip spica cast. This proactive approach prioritizes patient safety by ensuring adequate circulation and minimizing the risk of complications associated with impaired blood flow. By adhering to evidence-based practice guidelines and maintaining vigilance in monitoring patient status, healthcare professionals can optimize outcomes and promote the effective healing and management of patients with plaster casts.

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When a client with cystic fibrosis is prescribed pancreatic enzymes, what is the best time for the nurse to administer them to the client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A 3-week-old patient is hospitalized for surgical repair of hypertrophic pyloric stenosis. On the third postoperative day, the mother expresses concern that her infant vomited approximately one-fourth of his feeding. Which response by the nurse would be most appropriate at this time?

Correct Answer is B

Explanation

A patient is placed in a plaster hip spica cast and is returned to the assigned room. The cast is still slightly wet. Which action by the nurse would be appropriate?

Correct Answer is D

Explanation

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