The nurse is preparing to administer an oral medication to a client with dysphagia. Which action should the nurse take?

Correct Answer: C

Rationale: In this scenario, the correct action for the nurse to take is option C: Administer the medication with a small amount of pudding. This is the best choice because pudding has a smooth texture that can help facilitate swallowing for a client with dysphagia. Option A, crushing the medication and mixing it with applesauce, may not be suitable for all medications and can alter their effectiveness or cause an adverse reaction. Option B, having the client drink a full glass of water with the medication, may not address the swallowing difficulties associated with dysphagia and could lead to aspiration. Option D, placing the medication at the back of the client's tongue, can also increase the risk of aspiration and is not a recommended practice for clients with dysphagia. In an educational context, understanding the appropriate methods for administering medications to clients with dysphagia is crucial for nurses working in community health settings. Nurses must prioritize patient safety and comfort when managing medication administration for clients with specific health needs like dysphagia. By selecting the correct option, nurses can ensure that clients receive their medications safely and effectively.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Absence of breath sounds, which requires immediate intervention. This finding indicates a potential critical situation where there is little to no air moving in the lungs, which could be a sign of a severe asthma exacerbation or even a life-threatening condition like pneumothorax. Immediate action is needed to assess and intervene to ensure the client's airway is patent and they are able to breathe effectively. Option A) Increased respiratory rate is a common symptom of asthma exacerbation but may not always indicate an immediate life-threatening situation. Option C) Expiratory wheezes are also common in asthma and indicate narrowed airways but may not be as critical as the absence of breath sounds. Option D) Productive cough with green sputum may suggest a respiratory infection but does not require immediate intervention as the absence of breath sounds. In an educational context, this question highlights the importance of recognizing critical findings in clients with asthma and the need for prompt assessment and intervention in such situations to ensure client safety and well-being. It also emphasizes the significance of thorough assessment skills in community health nursing to provide timely and appropriate care to clients in various settings.

Correct Answer: C

Rationale: In evaluating a program designed to reduce the incidence of diabetes in the community, the most critical outcome indicating success is a reduction in the incidence of diabetes-related complications (Option C). This outcome directly reflects the effectiveness of the program in preventing the progression of the disease and reducing the burden on individuals and the healthcare system. Option A, increased participation in diabetes education sessions, is valuable for raising awareness and knowledge but does not directly measure the program's impact on disease incidence. Option B, higher rates of blood glucose monitoring, indicate improved management but do not necessarily show a decrease in new diabetes cases. Option D, greater knowledge of diabetes prevention methods, is important but does not guarantee a reduction in the actual occurrence of diabetes in the community. In an educational context, understanding the significance of outcome evaluation in community health programs is vital for nurses to assess the effectiveness of interventions. By focusing on measurable outcomes like reduced disease incidence, nurses can make informed decisions to improve community health outcomes and allocate resources effectively.

Correct Answer: C

Rationale: In this scenario, the finding that requires immediate intervention is "C) Tremors." Tremors are a sign of neuroglycopenia, which indicates severe hypoglycemia and potential brain damage if left untreated. Immediate action is needed to prevent further complications. Option A, "Blood glucose of 60 mg/dL," is not the most critical finding in this situation. While it indicates hypoglycemia, symptoms like tremors take precedence as they reflect the body's response to low glucose levels. Option B, "Heart rate of 100 beats per minute," can be a common physiological response to hypoglycemia and may not require immediate intervention unless it is associated with other severe symptoms. Option D, "Diaphoresis," while a symptom of hypoglycemia, is not as urgent as tremors in this case. Diaphoresis can be managed once the immediate threat of neuroglycopenia is addressed. Educationally, this question highlights the importance of recognizing and prioritizing symptoms in managing hypoglycemia effectively. It emphasizes the significance of understanding the hierarchy of interventions in emergency situations to provide optimal care for clients with diabetes mellitus.

Correct Answer: B

Rationale: In this scenario, option B, "I will change my colostomy bag every week," indicates a need for further teaching. This statement is incorrect because colostomy bags should be changed more frequently, typically every 3-7 days or sooner if needed to prevent leakage or odor. Option A, "I will avoid foods that cause gas," is a correct statement as certain foods can increase gas production, leading to discomfort and potential issues with the colostomy bag seal. Option C, "I will use a skin barrier to protect the skin around the stoma," is also a correct statement as using a skin barrier helps prevent skin breakdown and irritation from stool contact. Option D, "I will empty my colostomy bag when it is one-third full," is a correct statement as it is recommended to empty the bag when it is about one-third to one-half full to prevent leakage and ensure comfort for the client. Educationally, this question highlights the importance of accurate client education in caring for a colostomy. It emphasizes the need for frequent bag changes, proper skin protection, timely emptying of the bag, and dietary considerations to ensure optimal colostomy care and client comfort.