Correct Answer: A

Rationale: Applying a skin barrier around the stoma protects the peristomal skin from irritation and breakdown caused by contact with stool, a common issue with a new colostomy.
Choice B is incorrect because the colostomy bag should be emptied when it is one-third to one-half full to prevent leakage and skin irritation, not when full.
Choice C is incorrect because the colostomy appliance is typically changed every 3-7 days, not daily, unless there is leakage or skin irritation.
Choice D is incorrect because petroleum jelly is not recommended, as it can interfere with the adhesion of the colostomy appliance; a skin barrier or protective paste is preferred.

Correct Answer: B

Rationale: Swelling in the affected leg may indicate deep-vein thrombosis, requiring provider notification. Pain, mild fever, and normal heart rate are expected.

Correct Answer: A

Rationale: Encouraging the client to push with each contraction during the second stage of labor (from full cervical dilation to delivery) is appropriate, as it facilitates fetal descent and delivery, aligning with the client's natural urges to push.
Choice B is wrong because positioning the client supine with legs elevated is not recommended; it can compress the inferior vena cava, reduce uterine blood flow, and impede pushing efforts. Upright or lateral positions are preferred.
Choice C is wrong because applying fundal pressure is not a standard practice and can cause maternal or fetal injury, such as uterine rupture or shoulder dystocia.
Choice D is wrong because instructing the client to hold her breath while pushing (Valsalva maneuver) can decrease oxygen to the fetus and increase maternal fatigue; open-glottis pushing (exhaling while pushing) is preferred.

Correct Answer: B

Rationale: Avoiding alcohol is critical while taking methotrexate, as alcohol increases the risk of hepatotoxicity, a serious side effect of this immunosuppressive drug used for rheumatoid arthritis.
Choice A is incorrect because methotrexate can be taken with or without food, but a high-fat meal is not specifically recommended and may not affect absorption.
Choice C is incorrect because methotrexate takes weeks to months to relieve joint pain; it is not an immediate-acting analgesic.
Choice D is incorrect because methotrexate is typically taken once weekly (not daily at bedtime) to reduce systemic toxicity, and timing is flexible.

Correct Answer: A

Rationale: The nurse should ensure the state health department has been notified of the child's Lyme disease, as it is a reportable disease in most states. Reporting helps to monitor the incidence and prevalence of Lyme disease and to implement prevention and control measures.
Choice B is wrong because antitoxin is not used to treat Lyme disease. Antitoxin is a substance that neutralizes the effects of a toxin, such as botulism or tetanus. Lyme disease is caused by a bacterium called Borrelia burgdorferi, which can be treated with antibiotics.
Choice C is wrong because Lyme disease is not transmitted by sharing personal belongings. Lyme disease is spread to humans by the bite of infected ticks that carry the bacterium. The risk of getting Lyme disease can be reduced by avoiding tick-infested areas, wearing protective clothing, using insect repellent, and removing ticks promptly.
Choice D is wrong because skin necrosis is not a common complication of Lyme disease. Skin necrosis is the death of skin tissue due to lack of blood supply or infection. Lyme disease can cause a characteristic skin rash called erythema migrans, which is usually circular or oval and expands over time. Other possible signs and symptoms of Lyme disease include fever, headache, fatigue, joint pain, and neurological problems.