A nurse is providing discharge teaching to a client who has acute leukemia and received chemotherapy 12 hours ago. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)

Use an electric shaver.

Avoid crowds.

Take temperature weekly.

Consume a low-residue diet.

Monitor for bruising.

Answer and Explanation

Correct Answer : A,B,E

Choice A Reason:

Using an electric shaver is recommended for clients who have received chemotherapy because it reduces the risk of cuts and bleeding. Chemotherapy can lower platelet counts, leading to an increased risk of bleeding. Traditional razors can cause nicks and cuts, which can be problematic for clients with low platelet counts.

Choice B Reason:

Avoiding crowds is crucial for clients who have received chemotherapy because their immune systems are often weakened, making them more susceptible to infections. Crowded places increase the risk of exposure to pathogens, which can lead to serious infections in immunocompromised individuals.

Choice C Reason:

Taking temperature weekly is not sufficient for clients who have received chemotherapy. These clients are at a higher risk of infections, and any sign of fever should be monitored closely. It is generally recommended to take the temperature daily or more frequently if the client feels unwell.

Choice D Reason:

Consuming a low-residue diet is not typically necessary for clients who have received chemotherapy unless they are experiencing specific gastrointestinal issues. A balanced diet with adequate nutrients is usually recommended to support overall health and recovery.

Choice E Reason:

Monitoring for bruising is important for clients who have received chemotherapy because it can indicate low platelet counts or other bleeding disorders. Early detection of bruising can help in managing and preventing more serious bleeding complications.

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Correct Answer is C

Explanation

Choice A Reason

Axillary temperature 37.2° C (99° F). This temperature is within the normal range and does not indicate an immediate need for intervention. Normal body temperature ranges from 36.1° C to 37.2° C (97° F to 99° F).

Choice B Reason

Apical pulse 100/min. While a pulse rate of 100 beats per minute is on the higher end of the normal range, it is not necessarily indicative of an immediate life-threatening condition. Normal resting heart rate for adults ranges from 60 to 100 beats per minute.

Choice C Reason

Respiratory rate 30/min. This is the correct answer. A respiratory rate of 30 breaths per minute is significantly higher than the normal range of 12 to 20 breaths per minute for adults. This could indicate respiratory distress or other complications that require immediate intervention.

Choice D Reason

Blood pressure 140/84 mm Hg. While this blood pressure reading is elevated and may require monitoring, it does not indicate an immediate life-threatening condition. Normal blood pressure is typically around 120/80 mm Hg, but a reading of 140/84 mm Hg is not uncommon and can be managed with appropriate care.

A. Lemonade B. Tomato soup C. Gelatin D. Black coffee

Correct Answer is C

Explanation

Choice A Reason

Lemonade is not suitable for a client with acute gastritis. Lemonade is acidic and can irritate the stomach lining, potentially worsening the symptoms of gastritis. It is important to avoid acidic foods and beverages to prevent further irritation.

Choice B Reason

Tomato soup is also not recommended for a client with acute gastritis. Tomatoes are acidic and can exacerbate gastritis symptoms. Foods that are low in acidity are better choices for individuals with this condition.

Choice C Reason

Gelatin is the correct choice. It is bland, non-acidic, and easy to digest, making it suitable for someone recovering from acute gastritis. Gelatin can help soothe the stomach lining without causing irritation.

Choice D Reason

Black coffee should be avoided by clients with acute gastritis. Coffee is acidic and can irritate the stomach lining, leading to increased discomfort and symptoms. Caffeine can also stimulate acid production, which is not ideal for someone with gastritis.

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A nurse is providing discharge teaching to a client who has acute leukemia and received chemotherapy 12 hours ago. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)

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