The nurse is planning interventions for a patient with xerostomia. What will the nurse include in the patient's plan of care? Standard Text: Select all that apply.
1. Use a mouth rinse.
2. Avoid artificial lubricants.
3. Place a humidifier next to the bed.
4. Avoid foods that are difficult to chew or swallow.
5. Use sugar-free chewing gum, hard candies, and mints.
Question 2A nurse aide reports to the nurse that a 94-year-old client's rectal temperature is 35.8C. The nurse interprets this value as
A) a sign of infection.
B) a normal value for older clients.
C) an inaccurate reading by the nurse aide.
D) a sign of anemia.
Question 3An older patient has a significant amount of dental plaque. What can the nurse include when instructing the patient about brushing the teeth and gums?
1. Use a foam swab and brush three times a day for 3 to 4 minutes.
2. Use a soft-bristled toothbrush at bedtime and brush for 1 minute.
3. Use a soft-bristled toothbrush and brush twice a day for 3 to 4 minutes.
4. Use a medium to hard-bristled toothbrush and brush twice a day for 3 to 4 minutes.
Question 4A newly licensed nurse is preparing to provide postmortem care to a client. The nurse approaches the preceptor and states that she has never done this before and she is nervous. What is the best response by the preceptor?
A) It's just a dead body, it can't hurt you.
B) It is an important part of care; we need to show the family that the person was valued and respected. I can understand that you are nervous.
C) The families typically don't care about the body once the person is dead.
D) You can delegate this to the nursing assistant. Tell her to clean the body up when she is finished with her other work.
Question 5An older patient with oral candidiasis is prescribed Nystatin. Which actions will the nurse take when using this preparation with the patient? Standard Text: Select all that apply.
1. Plan to use the medication four times a day for 2 weeks.
2. Soak dentures in 1 mL of the medication and water for at least 6 hours.
3. Teach to hold the solution in the mouth and swish for 2 minutes before swallowing.
4. Coat the gums and tongue with the medication and rinse with water after 5 minutes.
5. Provide the medication as a troche to be used twice a day if the patient has diabetes.
Question 6A student nurse is caring for a dying client. The client is receiving oxygen and is open-mouthed breathing. The client's gag reflex is not present. Which is the best intervention for the student to care for the client's oral cavity?
A) Frequent oral care with a soft swab and an alcohol-based mouthwash
B) Frequent oral care with a soft swab with a salt-soda solution
C) Frequent oral care with lemon-glycerin swabs
D) Frequent oral care with a soft swab and ice chips
Question 7A hospice nurse is caring for a client who is dying. The client has been prescribed morphine for pain control. The client recently had the dosage increased to adequately control the pain.
The client asks the nurse, Am I addicted to this now? What is the best response by the nurse?
A) Needing to increase your dose does not mean you are addicted. Sometimes our bodies become adjusted to the dose of the medication and so we need to increase the dose to get the same effect.
B) You don't need to be worried about being addicted.
C) People who take morphine for cancer pain can't become addicted.
D) Being addicted to morphine is the least of your worries right now.
Question 8An older patient tells the nurse that tooth brushing is seldom done. What should the nurse assess as reasons why the patient has stopped performing oral hygiene? Standard Text: Select all that apply.
1. Vision changes
2. Malocclusion of teeth
3. Decrease in taste acuity
4. Lack of dental insurance
5. Loss of manual dexterity
Question 9A long-term care nurse is caring for a client who is dying. The client has complained of pain for several days. What is the best way to treat pain at the end of life?
A) Use long-acting medications that are given routinely.
B) Give immediate-release medications when the client complains of pain.
C) Give long-acting medications routinely and immediate-release doses when the client complains of breakthrough pain.
D) Give immediate-release medications routinely.
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