The nurse makes a home care visit to a client with a diagnosis of right sided stroke. The client's spouse reports that she was recently diagnosed with gastroenteritis and is having frequent loose stools. The nurse is most concerned with which observation?

The spouse washes their hands frequently with soap and water.

The spouse drinks electrolyte solution.

The spouse prepares lunch for the client.

The spouse uses a separate tube of toothpaste.

Answer and Explanation

The Correct Answer is C

A.   Frequent handwashing is critical in preventing the spread of infections, especially when one person in the household is ill with gastroenteritis. This practice indicates good hygiene and care for the client.
B.   Drinking an electrolyte solution can help the spouse stay hydrated, especially when experiencing frequent loose stools due to gastroenteritis. Staying hydrated is essential for recovery.
C.   If the spouse is actively preparing food for the client while having gastroenteritis, there is a risk of contaminating the food, which could lead to the client becoming ill. The client may be more vulnerable to infections, particularly following a stroke, and it is crucial to prevent exposure to any pathogens.
D.   This observation is a good practice as it helps prevent the spread of germs. Using separate personal items, like a toothbrush and toothpaste, can minimize the risk of transmitting infections.

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Correct Answer is ["C","E"]

Explanation

A. Encouraging a child with hypoglycemia to ambulate can be dangerous. Physical activity can further lower blood sugar levels, which could exacerbate the situation. It’s better to keep the child stable and provide treatment for the low blood sugar.
B. Waiting to confirm the blood glucose reading is not appropriate in this case. A blood glucose level of 50 mg/dL requires immediate intervention, not a delay. The priority is to treat the hypoglycemia right away.
C. Providing a fast-acting carbohydrate, like a tablespoon of honey, is an appropriate intervention for treating hypoglycemia. Other options could include glucose tablets or juice. The key is to quickly raise the blood sugar level.
D. Administering insulin when blood glucose levels are low is contraindicated. Insulin would further decrease the blood sugar level, worsening the hypoglycemic state. The priority is to treat the low blood sugar, not to give insulin.
E. If the child becomes unconscious due to hypoglycemia and is unable to swallow, glucagon should be prepared for administration. Glucagon can help raise blood sugar levels in emergency situations.

A. Scatter rugs are present in the kitchen. B. Uses a microwave for cooking. C. Handrails are present in the bathroom D. Electrical cords are placed along the walls.

Correct Answer is A

Explanation

A. This is a significant safety risk. Scatter rugs can easily be a tripping hazard, especially for individuals with decreased vision. They can slip or shift, leading to falls, which are a major concern for older adults.
B. Using a microwave is often a better option for older adults, as it reduces the need to handle pots and pans on the stovetop, which can be more hazardous for those with vision impairments. It allows for safer meal preparation.

C. Handrails provide support and stability, helping to prevent falls, especially in a room like the bathroom, where wet surfaces can create hazards. This is a positive aspect of the home environment.D
D. While placing electrical cords along the walls can minimize tripping hazards, it can still pose a risk if they are not secured properly or if they cross pathways in a way that is not visible to someone with decreased vision. However, this is generally less of a risk compared to scatter rugs.

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The nurse makes a home care visit to a client with a diagnosis of right sided stroke. The client's spouse reports that she was recently diagnosed with gastroenteritis and is having frequent loose stools. The nurse is most concerned with which observation?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse should implement which interventions for a child with type 1 diabetes who has a blood glucose level of 50 mg/dL? (Select All that Apply)

Correct Answer is ["C","E"]

Explanation

A home health nurse is assessing an older adult client in the home who has decreased vision due to a history of glaucoma. Which of the following findings should the nurse identify as a safety risk?

Correct Answer is A

Explanation

The nurse makes a home care visit to a client with a diagnosis of right sided stroke. The client's spouse reports that she was recently diagnosed with gastroenteritis and is having frequent loose stools. The nurse is most concerned with which observation?

A client with bacterial pneumonia is admitted to the pediatric unit. What would the nurse expect the admitting assessment to reveal?

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