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The nurse is preparing the client for discharge.

Exhibits

Which of the following statements indicate the client understands the discharge teaching?

Select the 3 client statements that indicate an understanding of the teaching.

“I can continue my current alcohol intake."

“I can expect my contact lenses to turn red or orange."

“I will need to take my medications for a total of 6 weeks."

“I will need to have a repeat Mantoux test in 4 weeks."

"I am no longer contagious."

“I should notify my provider if I start taking new over-the-counter or prescription medications."

“I will need to have someone observe me when I take medication."

Answer and Explanation

Correct Answer : B,F,G

A. "I can continue my current alcohol intake." The client should avoid alcohol while taking tuberculosis (TB) medications such as isoniazid and rifampin, as alcohol increases the risk of hepatotoxicity.
B. "I can expect my contact lenses to turn red or orange." Rifampin, a common medication used to treat TB, can cause bodily fluids such as urine, sweat, tears, and saliva to turn red or orange. This can stain soft contact lenses permanently, so clients should be informed of this side effect.
C. "I will need to take my medications for a total of 6 weeks." The standard treatment for TB typically lasts at least 6 months, not just 6 weeks. Clients must complete the full course of therapy to prevent drug resistance and recurrence.
D. "I will need to have a repeat Mantoux test in 4 weeks." A Mantoux test (tuberculin skin test) is not needed after a confirmed TB diagnosis with a positive sputum culture. Instead, follow-up evaluations include repeat sputum cultures and chest x-rays.
E. "I am no longer contagious." Clients with active pulmonary TB are considered contagious until they have completed at least two weeks of effective treatment, have improving symptoms, and have three consecutive negative sputum cultures.
F. "I should notify my provider if I start taking new over-the-counter or prescription medications." TB medications, especially rifampin, can interact with many drugs, including oral contraceptives, anticoagulants, and antiretrovirals. Clients must inform their provider of any new medications.
G. "I will need to have someone observe me when I take medication." Directly observed therapy (DOT) is recommended for clients with TB to ensure medication adherence and reduce the risk of treatment failure or drug resistance.

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Correct Answer is A

Explanation

A. Anterior fontanel closed. The anterior fontanel typically closes between 12 to 18 months of age. Closure at 4 months is premature and may indicate conditions such as craniosynostosis, which can affect skull and brain development. The provider should be notified for further evaluation.
B. Moves objects to mouth. This is an expected developmental milestone for a 4-month-old infant. At this age, infants begin to grasp objects and bring them to their mouths as part of their sensory exploration.
C. Rolls from back to abdomen. Most infants begin rolling from back to abdomen around 5 to 6 months. If a 4-month-old achieves this milestone early, it is not necessarily concerning but rather an indication of advanced motor development.
D. Posterior fontanel closed. The posterior fontanel typically closes between 6 to 8 weeks of age, so closure by 4 months is expected and does not require provider notification.

A. Place a pillow under the client's head. B. Gently restrain the client's arms. C. Administer a muscle relaxant. D. Insert a tongue blade.

Correct Answer is A

Explanation

A. Place a pillow under the client's head. Placing a pillow under the client's head is appropriate as it helps protect the client's head from injury during the seizure. Providing cushioning can reduce the risk of head trauma, which is a common concern during seizures.
B. Gently restrain the client's arms. Gently restraining the client's arms is not recommended during a seizure, as it can lead to injury. Restraining movements can also increase the risk of injury to both the client and the caregiver. Instead, the nurse should allow the seizure to progress without interference.
C. Administer a muscle relaxant. Administering a muscle relaxant is not appropriate during a seizure. The nurse should not medicate the client until the seizure has stopped and the healthcare provider has assessed the situation. Immediate management focuses on safety rather than medication.
D. Insert a tongue blade. Inserting a tongue blade or any object into the client's mouth is dangerous and not recommended. This can cause oral injury, broken teeth, or airway obstruction. The nurse should ensure the area is clear of hazards and allow the seizure to occur without attempting to prevent movements.

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The nurse is preparing the client for discharge. Exhibits Which of the following statements indicate the client understands the discharge teaching? Select the 3 client statements that indicate an understanding of the teaching.

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The nurse is preparing the client for discharge.

Exhibits

Which of the following statements indicate the client understands the discharge teaching?

Select the 3 client statements that indicate an understanding of the teaching.