The daughter of an older woman who has Parkinson's disease, calls the clinic and reports that her mother has been confused for the past week. Which action(s) should the nurse take? (Select all that apply.)

Determine if the mother has recently experienced a fall.

Review the client's current food and medication allergies.

Encourage increased intake of high protein foods.

Instruct the daughter to check her mother's temperature.

Ask if the mother is experiencing any pain with urination.

Answer and Explanation

Correct Answer : A,D,E

Choice A reason: This is a correct answer because determining if the mother has recently experienced a fall is important to rule out any head injury or concussion that could cause confusion. Parkinson's disease can increase the risk of falls due to impaired balance, coordination, and mobility.

Choice B reason: This is not a correct answer because reviewing the client's current food and medication allergies is not relevant to the mother's confusion. However, it may be important to review the client's current medications and dosages to check for any adverse effects or interactions that could affect cognition.

Choice C reason: This is not a correct answer because encouraging increased intake of high protein foods is not helpful for the mother's confusion. In fact, high protein foods may interfere with the absorption of levodopa, a medication used to treat Parkinson's disease symptoms. The nurse should advise the daughter to consult with a dietitian about the optimal timing and amount of protein intake for her mother.

Choice D reason: This is a correct answer because instructing the daughter to check her mother's temperature is important to detect any fever or infection that could cause confusion. Older adults are more susceptible to infections such as urinary tract infections (UTIs), pneumonia, or sepsis, whih can affect mental status.

Choice E reason: This is a correct answer because asking if the mother is experiencing any pain with urination is important to screen for any UTI that could cause confusion. UTIs are common in older adults due to reduced bladder function, incomplete emptying, and decreased immunity. UTIs can cause symptoms such as dysuria, frequency, urgency, hematuria, and delirium.

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Correct Answer is B

Explanation

Choice A reason: Flushed, peeling skin is not a specific finding for scarlet fever. Flushed, peeling skin can be caused by various factors, such as sunburn, dehydration, allergic reaction, or infection. Scarlet fever is a condition that results from a Streptococcal infection in the throat or skin that produces toxins that cause a rash and fever. The rash usually begins on the neck and chest and then spreads to other parts of the body.

Choice B reason: This is the correct answer because red bumps across chest are a characteristic finding for scarlet fever. Red bumps across chest are part of the rash that develops due to toxins produced by Streptococcal bacteria. The rash usually feels like sandpaper and may be accompanied by itching or burning sensations. The rash typically lasts for about a week and then fades, leaving behind peeling skin.

Choice C reason: White coating on tongue is not a clear indication for scarlet fever. White coating on tongue can be caused by various factors, such as dehydration, poor oral hygiene, fungal infection, or inflammation. Scarlet fever may cause white patches or red spots on the tongue, but this is not a distinctive feature of scarlet fever.

Choice D reason: High, protracted fever is not a unique finding for scarlet fever. High, protracted fever can be caused by various factors, such as infection, inflammation, dehydration, or immunological disorder. Scarlet fever may cause high fever (above 101°F or 38.3°C), but this is not a definitive sign of scarlet fever.

A. Increase the intake of dark green leafy vegetables while taking warfarin. B. Eat two servings of dark green leafy vegetables daily and continue for 30 days after warfarin therapy is completed. C. Eat approximately the same amount of leafy green vegetables daily so the amount of vitamin K consumed is consistent. D. Avoid eating any foods that contain any vitamin K because it is an antagonist of warfarin.

Correct Answer is C

Explanation

Choice A reason: Increasing the intake of dark green leafy vegetables while taking warfarin is not a good instruction because it can decrease the effectiveness of warfarin. Dark green leafy vegetables are rich in vitamin K, which is a coagulation factor that counteracts the anticoagulant effect of warfarin.

Choice B reason: Eating two servings of dark green leafy vegetables daily and continuing for 30 days after warfarin therapy is completed is not a good instruction because it can cause bleeding complications. Dark green leafy vegetables are rich in vitamin K, which is a coagulation factor that counteracts the anticoagulant effect of warfarin. Stopping warfarin while continuing to eat high amounts of vitamin K can increase the risk of clot formation and thromboembolism.

Choice C reason: This is the correct answer because eating approximately the same amount of leafy green vegetables daily so the amount of vitamin K consumed is consistent is a good instruction because it can help maintain a stable therapeutic level of warfarin. Dark green leafy vegetables are rich in vitamin K, which is a coagulation factor that counteracts the anticoagulant effect of warfarin. Keeping a consistent intake of vitamin K can help avoid fluctuations in warfarin's effect and prevent bleeding or clotting episodes.

Choice D reason: Avoiding eating any foods that contain any vitamin K because it is an antagonist of warfarin is not a good instruction because it can cause bleeding complications. Dark green leafy vegetables are rich in vitamin K, which is a coagulation factor that counteracts the anticoagulant effect of warfarin. Eliminating vitamin K from the diet can increase the sensitivity to warfarin and cause excessive bleeding and bruising.

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The daughter of an older woman who has Parkinson's disease, calls the clinic and reports that her mother has been confused for the past week. Which action(s) should the nurse take? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A preschool-aged child who is being tested for Streptococcal pharyngitis returns to the clinic for signs of scarlet fever. Which assessment finding provides the clearest indication to the nurse that the child is experiencing a reaction to toxins that are created by Streptococcal bacteria?

Correct Answer is B

Explanation

A client is being discharged with a prescription for warfarin. Which instruction should the nurse provide this client regarding diet?

Correct Answer is C

Explanation

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