Which of the ff instructions should a nurse give a client with non-Hodgkin’s lymphoma who is being treated with radiation and chemotherapy?

Correct Answer: A

Rationale: The correct answer is A: Increase fluid intake. This is important for a client undergoing radiation and chemotherapy for non-Hodgkin's lymphoma to prevent dehydration, help flush out toxins, and support kidney function. Increasing fluid intake can also help manage side effects like nausea and vomiting. Choices B, C, and D are incorrect because low-fat meals, soft bland foods, and foods rich in folic acid are not specifically indicated for clients undergoing radiation and chemotherapy for non-Hodgkin's lymphoma.

Correct Answer: C

Rationale: The correct answer is C because it helps the patient explore her support system. By asking who she usually goes to when facing problems, the nurse encourages the patient to identify her sources of emotional support, which can help her cope with the new diagnosis. This response acknowledges the patient's need for support and fosters a therapeutic relationship. Explanation for incorrect choices: A: "Don't worry. You'll be okay." - This response dismisses the patient's feelings and offers false reassurance, which may not address her emotional needs. B: "The treatments you are receiving will make you feel better very soon." - While this statement provides information about treatment, it does not directly address the patient's difficulty in coping with the diagnosis. D: "Have you made end-of-life decisions?" - This response may be premature and could unnecessarily increase the patient's anxiety about her prognosis.

Correct Answer: D

Rationale: The correct answer is D because individuals with AB blood type are considered universal recipients, meaning they can receive blood from any blood type without risking complications due to incompatibility. This is because their blood cells have both A and B antigens and do not produce antibodies against either type. Therefore, the client can safely receive blood from types A, B, AB, or O without adverse reactions. Choices A, B, and C are incorrect because they limit the options for blood transfusion based on the client's AB blood type, which is not necessary given the unique nature of AB blood as universal recipients.

Correct Answer: A

Rationale: The correct answer is A: Increased ICP. Decreasing level of consciousness is a classic sign of increased intracranial pressure (ICP) due to the compression of the brain. As ICP rises, it impairs cerebral perfusion leading to altered mental status. Parasympathetic response (B) and sympathetic response (C) are related to autonomic nervous system functions, not consciousness. Increased cerebral blood flow (D) might lead to conditions like hyperemia but does not directly cause a decreased level of consciousness.

Correct Answer: B

Rationale: The correct answer is B: Monitor temperature every 4hrs. This is crucial in detecting signs of urinary tract infection as fever is a common symptom. Monitoring temperature regularly allows for early detection and appropriate intervention. A: Encouraging the client to breathe deeply and cough every 2hrs is a measure to prevent respiratory complications postoperatively, not related to UTI detection. C: Splinting the incision when repositioning the client is important for wound care, not for detecting UTI. D: Irrigating tubes as ordered is a specific intervention for tube care, not for monitoring UTI symptoms.

Correct Answer: B

Rationale: The correct answer is B because the patient's Body Mass Index (BMI) indicates obesity, putting them at higher risk for surgical complications. Obesity is associated with increased risks of infections, delayed wound healing, respiratory issues, and cardiovascular problems post-surgery. Monitoring this patient closely is crucial. Choice A is less likely to have increased surgical complications due to age and condition. Choice C, a 12-year-old, is less likely to have significant surgical complications compared to adults. Choice D, a 17-year-old with gallstones, may have risks but the BMI of the patient in choice B indicates a higher risk.

Correct Answer: B

Rationale: The correct answer is B: Take the NSAID with meals. Taking NSAIDs with meals helps reduce stomach irritation and risk of developing ulcers. Food acts as a protective barrier and helps in the absorption of the medication. Incorrect Choices: A: Taking NSAID with aspirin can increase the risk of stomach irritation and bleeding due to combined antiplatelet effects. C: Orange juice does not potentiate the effect of NSAIDs and may even worsen stomach irritation due to its acidity. D: NSAIDs do not coat the stomach lining; in fact, they can irritate the stomach lining and increase the risk of ulcers.

Correct Answer: C

Rationale: The correct answer is C because data validation involves comparing data with other sources to ensure accuracy. This process checks for errors, inconsistencies, and completeness in the data. By comparing data with other sources, nurses can verify the reliability and correctness of the information. Choice A is incorrect because data validation typically occurs after data collection and before data interpretation. Choice B is incorrect because validation is about ensuring data accuracy, not about professional standards. Choice D is incorrect because data interpretation focuses on analyzing and making sense of the data, not on professional standards or validation processes.

Correct Answer: C

Rationale: The correct answer is C because performing chest physiotherapy (CPT) at least two hours after meals helps prevent aspiration during the procedure. This timing reduces the risk of vomiting or regurgitation of food during CPT, which could lead to aspiration pneumonia. Slapping the chest wall gently (A) may not effectively clear secretions. Using vibration techniques (B) is not typically recommended for routine CPT. Planning apical drainage at the beginning of the session (D) is not necessary as it is not a standard practice for CPT.