The client with rheumatoid arthritis reports GI irritation after taking piroxicam (Feldene). To prevent GI upset, the nurse should provide which instruction?

Correct Answer: C

Rationale: Piroxicam is a nonselective NSAID (nonsteroidal anti-inflammatory drug) that can irritate the gastrointestinal (GI) tract, leading to symptoms such as heartburn, indigestion, and stomach pain. Taking piroxicam with food or an oral antacid can help reduce GI irritation by providing a protective barrier and reducing acid production within the stomach. Encouraging the client to take piroxicam with a meal or antacid can help prevent or minimize GI upset associated with the medication. Additionally, using a proton pump inhibitor (PPI) or histamine-2 receptor antagonist (H2 blocker) along with piroxicam may further protect the stomach lining from irritation.

Correct Answer: D

Rationale: Cryoprecipitate is a blood product that contains concentrated amounts of clotting factors, including fibrinogen, Factor VIII, Factor XIII, and von Willebrand factor. These clotting factors are essential for the formation of blood clots, and when a patient has a bleeding disorder such as hemophilia or von Willebrand disease, cryoprecipitate is used to replace the missing or deficient clotting factors. Platelets are used to help with clot formation in cases of thrombocytopenia, albumin is used to treat low albumin levels in conditions like liver disease, and packed RBCs are used to treat anemia by providing oxygen-carrying red blood cells. However, for a patient with a bleeding disorder needing replacement of missing clotting factors, cryoprecipitate is the most appropriate blood product.

Correct Answer: B

Rationale: The best way to assess a patient's fatigue is to have her rate her fatigue on a scale of 0 to 10. Fatigue is primarily a subjective symptom, and patients are the best source of information regarding their own levels of fatigue. Using a standardized scale allows for a more quantitative assessment of the severity of the fatigue experienced by the patient. This can also help in monitoring changes in fatigue over time and evaluating the effectiveness of interventions aimed at managing fatigue. While observing the patient's activity level (choice A) can provide some information, it may not always accurately reflect the subjective experience of fatigue. Monitoring for changes in vital signs (choice C) and assessing hemoglobin and hematocrit values (choice D) can be important in evaluating overall health status and potential causes of fatigue, but they do not directly assess the patient's subjective experience of fatigue.

Correct Answer: A

Rationale: The client's platelet count of 50,000/ul is significantly low (normal range is around 150,000-450,000/ul). A low platelet count places the client at risk for bleeding tendencies. Therefore, the most appropriate nursing instruction to include in the teaching plan is bleeding precautions. This would involve educating the client on measures to prevent bleeding such as avoiding activities that may cause injury, using a soft toothbrush, avoiding tight clothing, and being cautious while shaving.

Correct Answer: A

Rationale: In caring for a client with lymphangitis, it is crucial for the nurse to be vigilant for any signs of worsening condition. The correct answer is option A, which states that the affected area appears to enlarge. This is the most critical symptom indicating progression of the infection along the lymphatic vessels. Enlargement suggests increasing inflammation and potential complications, necessitating immediate physician notification for further evaluation and intervention. Options B, C, and D are incorrect. Red streaks extending up the arm or leg (option B) are actually a classic sign of lymphangitis and should not trigger physician notification unless they worsen significantly or are accompanied by other concerning symptoms. Additional lymph nodes becoming involved (option C) is a common response to infection and does not necessarily warrant immediate physician notification unless they are unusually enlarged or painful. Enlargement of the liver and spleen (option D) is not directly related to lymphangitis and would typically be indicative of a different condition. In an educational context, understanding the progression of lymphangitis and recognizing concerning signs is crucial for nurses caring for pediatric patients. This knowledge helps in timely interventions and preventing complications. Nurses need to prioritize assessments and interventions based on the most critical indicators of worsening condition to provide optimal care for their patients.