A nurse is reinforcing teaching with a client who has stomatitis. Which of the following instructions should the nurse include in the teaching?
CONTINUE Eat foods high in vitamin B12-
Consume soft, bland foods.
Use lemon glycerin swabs.
Rinse the mouth with an alcohol-based mouthwash.
The Correct Answer is B
Choice A Reason:
Continuing to eat foods high in vitamin B12 is generally a good dietary choice, but it should be done in a way that minimizes irritation to the inflamed oral tissues. The client should choose foods that are soft and gentle on the mouth.
Choice B Reason:
Consume soft, bland foods is correct. When providing instructions to a client with stomatitis (inflammation of the mouth), it's important to recommend a diet that is gentle on the irritated oral tissues. Consuming soft, bland foods can help minimize further irritation and discomfort. Examples of suitable foods may include mashed potatoes, yogurt, oatmeal, applesauce, and other similar items that are easy to chew and swallow.
Choice C Reason:
Using lemon glycerin swabs is not recommended for clients with stomatitis. Lemon can be acidic and may further irritate the mouth. Glycerin swabs alone may be used for oral care, but the lemon component should be avoided.
Choice D Reason:
Rinsing the mouth with an alcohol-based mouthwash is not advisable for clients with stomatitis. Alcohol-based mouthwashes can be harsh and may exacerbate the irritation and pain associated with stomatitis. Clients should be encouraged to use non-alcoholic, mild oral rinses or saline rinses as recommended by their healthcare provider.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A Reason:
Determining the client's level of consciousness is correct. Delirium is characterized by a sudden change in mental status, including altered consciousness, confusion, and impaired attention. Assessing the client's level of consciousness helps the nurse understand the severity of the condition and whether the client is experiencing any immediate risks.
Choice B Reason:
Administer an anxiolytic medication is incorrect. Medication administration should not be the first action because the nurse needs to assess the client's condition first to determine if medication is appropriate. Additionally, the underlying cause of the delirium should be identified and treated if possible.
Choice C Reason:
Keep lights on in the client's room is incorrect. While maintaining proper lighting can be important for safety, it is not the first action because it doesn't address the underlying cause or assess the client's level of consciousness.
Choice D Reason:
Encouraging visits from family members is incorrect. Involving family members can provide emotional support, but it's not the first action because the client's condition should be assessed and stabilized before involving others in care.
Correct Answer is D
Explanation
Choice A Reason:
"I moved the television to my bedroom for background noise." Having a television in the bedroom can be disruptive to sleep because it can interfere with relaxation and contribute to increased screen time before bed.
Choice B Reason:
"I go to the 24-hour gym shortly before I go to bed." Exercising shortly before bedtime can stimulate the body and make it more difficult to fall asleep. It's generally recommended to finish exercise at least a few hours before bedtime.
Choice C Reason:
"I am eating dinner later in the evening." Eating a heavy meal or eating too close to bedtime can lead to discomfort and indigestion, making it harder to sleep. It's better to have dinner at least a few hours before bedtime.
Choice D Reason:
"I am going to bed at the same time every night." The statement "I am going to bed at the same time every night" indicates an understanding of sleep promotion because it reflects consistency in the client's sleep schedule. Maintaining a regular sleep schedule helps regulate the body's internal clock and promotes healthy sleep patterns.
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