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

Answer and Explanation

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.

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Correct Answer is D

Explanation

A. While vitamin K plays a role in immune function, its administration prior to surgery primarily aims to correct potential clotting abnormalities rather than prevent infection.

B. Vitamin K does not affect gastric secretions. Its role in this context is unrelated to gastric function.
C. While vitamin K is involved in various physiological processes, its administration prior to surgery is primarily aimed at preventing bleeding complications by ensuring adequate clotting factor synthesis.
D. Vitamin K is essential for the synthesis of clotting factors in the liver.

Administering vitamin K prior to surgery helps ensure adequate levels of clotting factors, reducing the risk of bleeding during and after the procedure.

A. Notify the health-care provider. B. Start oxygen at 2 L/min. C. Order an electrocardiogram and cardiac enzymes. D. Place bed in modified Trendelenburg position. E. Allow the patient to rest alone. F. Elevate the head of the bed.

Correct Answer is ["A","B","C","F"]

Explanation

A. Increased premature ventricular contractions along with symptoms of anxiety and shortness of breath may indicate worsening cardiac function or an acute cardiac event, necessitating immediate medical attention.
B. Oxygen therapy may help alleviate symptoms of shortness of breath and improve oxygenation in patients experiencing cardiac symptoms.
C. These diagnostic tests can provide valuable information about cardiac function and any potential myocardial damage or ischemia, helping guide further treatment and management.
D. The modified Trendelenburg position may increase cardiac workload, which is not beneficial in the case of PVCs.
E. The patient should not be left alone due to the need for ongoing assessment and potential rapid intervention. Furthermore, leaving them alone could worsen their anxiety.
F. Elevating the head of the bed can aid in breathing and comfort, reducing the sensation of breathlessness.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient is admitted to the hospital for a splenectomy. The nurse understands that the health-care provider prescribes an injection of vitamin K prior to surgery for which action?

Correct Answer is D

Explanation

A patient with a cardiac disorder is having increased premature ventricular contractions and feels "anxious" and short of breath. After vital signs are obtained, what actions should the nurse take? Select all that apply.

Correct Answer is ["A","B","C","F"]

Explanation

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