A patient receiving chemotherapy for chronic myelocytic leukemia has irritates mucous membranes. Which of the following mouth care interventions would the nurse include in the plan of care?
Swab teeth and mucous membranes four times daily with lemon-glycerin swabs
Brush teeth twice a day with a firm toothbrush
Use sponge Toothettes to clean teeth between meals
Use waxed floss between meals and at bedtime
The Correct Answer is C
A. Lemon-glycerin swabs can dry out and irritate oral tissues, increasing the risk of oral mucositis and infection.
B. Using a firm toothbrush may be too harsh for irritated mucous membranes and can increase the risk of injury and bleeding.
C. Gentle oral care is essential to avoid further irritation of the mucous membranes.
D. Flossing may be too abrasive for irritated mucous membranes and can increase the risk of bleeding and injury.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Older adults with UTIs may present with atypical symptoms such as confusion or acute changes in mental status, known as delirium, rather than classic urinary symptoms. This is often referred to as "geriatric UTI syndrome" and can be the only presenting symptom in some cases.
B. Incontinence can occur in individuals of all ages with UTIs and is not unique to older adults.
C. Urinary retention is not typically associated with UTIs in older adults; instead, they may experience urinary frequency and urgency.
D. Low back pain can occur in individuals of all ages with UTIs and is not unique to older adults.
Correct Answer is B
Explanation
A. Sanguineous drainage is typically bright red and composed mainly of red blood cells. It is common immediately after surgery but does not typically indicate infection.
B. Purulent drainage is thick, yellow, or greenish in color and contains pus, indicating infection. It requires prompt assessment and intervention.
C. Serous drainage is clear, watery, and pale yellow in color. It is typically a normal finding in surgical wounds.
D. Serosanguineous drainage is pink to pale red and contains a mixture of blood and serum. It is common in the early stages of wound healing.
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