When assessing a patient with a sore throat, the nurse notes anterior cervical lymph node swelling, a temperature of 101.6° F (38.7° C), and yellow patches on the tonsils. Which action will the nurse anticipate taking?
a. Teach the patient about the use of expectorants.
b. Use a swab to obtain a sample for a rapid strep antigen test.
c. Discuss the need to rinse the mouth out after using any inhalers.
d. Teach the patient to avoid use of nonsteroidal antiinflammatory drugs (NSAIDs).
ANS: B
The patient's clinical manifestations are consistent with streptococcal pharyngitis and the nurse will anticipate the need for a rapid strep antigen test and/or cultures. Because patients with streptococcal pharyngitis usually do not have a cough, use of expectorants will not be anticipated. Rinsing the mouth out after inhaler use may prevent fungal oral infections, but the patient's assessment data are not consistent with a fungal infection. NSAIDs are frequently prescribed for pain and fever relief with pharyngitis.
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The client delivered by cesarean birth three days ago, and is being discharged. Which statement should the nurse include in the discharge teaching?
A. "If your incision becomes increasingly painful, call the doctor." B. "It is normal for the incision to ooze greenish discharge in a few days." C. "Increasing redness around the incision is a part of the healing process." D. "A fever is to be expected because you had a surgical delivery."
The nurse is teaching a client about age-related changes in the skin. What should the nurse include in the teaching session? (Select all that apply.)
Note: Credit will be given only if all correct choices and no incorrect choices are selected. 1. Increase in skin tumors 2. Loss of elasticity 3. Fragile epidermis 4. Loss of hair follicles 5. Reduced ability to sweat
Which does the nurse observe for an adult client who has a negative Babinski response?
A. All toes turn inward. B. All toes curve upward. C. All toes spread outward. D. All toes bend downward.
Greta Mitchell is a nurse in an urban high school who has a significant number of pregnant girls attending her school. Greta is extremely concerned with the problems related to teen pregnancy. These include all of the following except
1. Children of teen parents tend to score lower on IQ tests and have more problems in school. 2. Health risks to the infant during pregnancy (e.g., prematurity and low birth weight) are greater in teens. 3. Teen mothers are less likely to finish high school and more likely to have low incomes and be welfare dependent. 4. Teen pregnancy appears to contribute to increases in substance use and abuse.