Interventions for Chemotherapy-Induced Nausea: Analyzing the Choices

The prompt describes a home health nurse caring for a client experiencing chemotherapy-induced nausea resistant to pharmacological interventions. We need to analyze the effectiveness of each offered intervention based on evidence and rationale:

a. Maintain the head of the client's bed in an elevated position after eating.

Rationale:

• Supportive:Some studies suggest elevating the head of the bed by 30-45 degrees might reduce gastroesophageal reflux and nausea after meals.However,the effectiveness remains inconclusive,and further research is needed.
• Potential drawbacks:This position may be uncomfortable for some clients,especially those with respiratory difficulties.

b. Provide sips of room-temperature ginger ale between meals.

Rationale:

• Supportive:Ginger has demonstrated antiemetic properties in several studies,potentially reducing nausea and vomiting.Room-temperature liquids are generally better tolerated than cold or hot ones for nausea.
• Considerations:The effectiveness of ginger may vary between individuals,and potential interactions with other medications should be checked.

c. Offer 120 mL (4 oz) of cold milk as a meal replacement.

Rationale:

• Unsupportive:Replacing meals with small volumes of milk is inadequate for nutritional needs and can worsen nausea due to an empty stomach.Chemotherapy can already impact appetite and nutrient intake,and offering small,frequent meals is generally recommended.
• Potential harm:Skipping meals can lead to electrolyte imbalances,dehydration,and further weaken the client.

d. Use seasonings to enhance the flavor of foods.

Rationale:

• Mixed evidence:While strong odors or unfamiliar flavors can trigger nausea in some clients,using bland or mild seasonings might not be universally effective.Some studies suggest offering preferred or familiar flavors based on individual preferences could improve appetite and tolerance.
• Individualization:Experimenting with different spices and flavors based on the client's preferences and observing their response is crucial.

e. Assist the client in using guided imagery.

Rationale:

• Supportive:Guided imagery is a relaxation technique that can help manage nausea by distracting the client from the unpleasant sensation and promoting feelings of calmness.Studies have shown its effectiveness in reducing nausea and vomiting in various contexts,including chemotherapy.
• Considerations:Not all clients may be receptive to guided imagery,and its success depends on individual preferences and practice.

In conclusion, the most appropriate interventions for the client include:

• Providing sips of room-temperature ginger ale between meals (choice b).
• Assisting the client in using guided imagery (choice e).

Choices a, c, and d require further evaluation or are not generally recommended based on current evidence.

The correct answer is choice C, Cognitive Behavioral Therapy.

Explanation: Cognitive-behavioral therapy (CBT) is a type of talk therapy that focuses on changing unhealthy patterns of thinking and behavior. CBT has been shown to be effective in treating alcohol use disorder by helping clients identify and change the thoughts and behaviors that lead to drinking. Options A, B, and D are incorrect because chelation therapy is used to treat heavy metal poisoning, naloxone is used to reverse opioid overdose, and methadone is used to treat opioid addiction.

The correct answer is choice B, Initiate a referral for the client to a social worker.

Explanation: The nurse should initiate a referral for the client to a social worker who can assist with financial and social issues related to the client's disability.

Offering to bring groceries to the client or contacting friends and neighbors are not sustainable long-term solutions. Providing information about respite care is not relevant to the client's immediate concern.

The correct answer is choice B, Occupational Safety and Health Administration.

Explanation: The symptoms reported by the group of technicians may indicate a workplace hazard, so the nurse should notify the Occupational Safety and Health

Administration (OSHA) to investigate the cause of the symptoms. The Environmental Protection Agency (EPA) is responsible for regulating the environment and may not be relevant in this case. The Centers for Disease Control and Prevention (CDC) and the Department of Health and Human Services (DHHS) are responsible for monitoring and responding to public health threats and are not appropriate for this situation.

The nurse should determine how the adolescent's health has affected family roles and responsibilities to identify areas where the family may need assistance. Directing the conversation solely to the parents or focusing on the adolescent's future career plans is not appropriate as it may exclude the adolescent from the discussion. Asking another family to attend the meeting is not necessary unless the family requests it.

The correct answer is choice D, the children. The epidemiological triangle is a model that helps in identifying and analyzing the causative factors of disease outbreaks. It consists of three elements: host, agent, and environment. In this case, the children are the host, as they are the ones who have contracted the disease. The virus (choice C) is the agent, as it is the causative factor of the disease. The school (choice A) and vaccine (choice B) are not the host or agent, but rather part of the environment. The school may be a setting where the outbreak occurred, while the vaccine is a preventive measure but is not directly involved in causing or treating the disease. Therefore, the correct answer is choice D, the children.

The correct answer is choice B, a client who has COPD and reports an oxygen saturation of 90%. An oxygen saturation of 90% is below the normal range, which is typically between 95% to 100%. This indicates that the client is not receiving enough oxygen, which could lead to respiratory distress or hypoxemia. As the nurse, it is important to prioritize this client as a lower oxygen saturation level may result in further complications. The mother reporting vomiting in choice A may be concerning, but it is a known side effect of methylphenidate, and the client should be monitored for any further symptoms. The purple appearance of a colostomy stoma in choice C may indicate ischemia or necrosis, but it is not an urgent concern and can be assessed during the next visit. The feeling of a vibration in a new arteriovenous graft for dialysis in choice D may indicate an arterial steal syndrome, but it is not a medical emergency, and the client can be instructed to follow up with the provider. Therefore, the correct answer is choice B.

The correct answer is choice D, analyzing findings from a facility tabletop disaster simulation. A tabletop exercise is a comprehensive method to test the disaster plan by simulating a disaster scenario in a non-threatening environment, allowing for the identification of strengths and weaknesses in the plan and the development of improvements. Option A assesses only the knowledge of staff members, but does not test the application of the plan in a disaster. Option B focuses on discussing disaster scenarios without testing the ability to apply the plan. Option C only evaluates staff's response to a disaster drill, which is not an ideal method for testing the plan's effectiveness since it is not a real disaster scenario. Therefore, analyzing findings from a facility tabletop disaster simulation is the most comprehensive method to determine the effectiveness of the disaster plan.

The correct answer is choice D, Scratching or piercing the skin. This behavior is known as self-harm or non-suicidal self-injury, and it is a maladaptive coping mechanism that can result from unmanaged stress or negative emotions. The nurse should identify this behavior as a priority and provide resources for the adolescent to seek professional help, including counseling or therapy.

Choice A, staying up all night playing online video games, can be a form of procrastination or avoidance but does not necessarily indicate a need for immediate intervention.

Choice B, listening to loud music for several hours, can also be a coping mechanism, but it is not necessarily harmful or maladaptive.

Choice C, talking about others on social media, maybe a negative behavior, but it does not indicate a need for immediate intervention unless it leads to cyberbullying or harassment.

The correct answer is choice A. Providing quiet time during visits for prayer or meditation is an appropriate intervention for a client who has been diagnosed with end-stage breast cancer. This intervention helps the client reduce stress, anxiety, and promote spiritual well-being. The faith community nurse should aim to provide holistic care that addresses the physical, emotional, social, and spiritual aspects of the client's health. The nurse should be aware of the client's cultural and religious beliefs and support the client in a way that aligns with these beliefs.

Choice Bis not the correct answer. Hospice services should be recommended based on the client's wishes and not suggested without discussion with the client. The nurse should provide the client with information about all available options and allow the client to make an informed decision.

Choice Cis not the correct answer. Placing the client's name and medical condition on an online prayer chain violates the client's privacy and confidentiality. The nurse should respect the client's wishes regarding sharing health information.

Choice D is not the correct answer. The nurse should encourage the client to express feelings and concerns about their health status. The nurse should be an active listener and provide emotional support to the client.

The correct answer is Choice A because, Double-bag soiled dressings in polyethylene bags. The nurse should double-bag soiled dressings in polyethylene bags to contain the infection and prevent the spread of methicillin-resistant Staphylococcus aureus (MRSA). The bags should be securely tied and labeled as contaminated.

Choice B is wrong because, Encourage the client to use a HEPA filter in the house, is not the correct answer because a HEPA filter is not effective in controlling the spread of MRSA.

Choice C is wrong because, Wear a mask when within 3 feet of the client, is not the correct answer because wearing a mask is not necessary unless the nurse is providing direct care to the client and is within 3 feet of them.

Choice D is wrong because, Remove fresh flowers from the client's home, is not the correct answer because fresh flowers are not a source of MRSA.

The correct answer is Choice A because, "I am obese because it's in my genes." The client is using rationalization as a coping mechanism by justifying their obesity as being predetermined by their genes, rather than acknowledging their personal responsibility in managing their weight. Rationalization is a defense mechanism in which a person gives a false or socially acceptable explanation for an unacceptable behavior or situation.

Choice B is wrong because, "I have difficulty resisting the items in vending machines," is not the correct answer because it is an excuse rather than a rationalization.

Choice C is wrong because, "I know you don't like me because I am obese," is not the correct answer because it is an example of projection, in which the client attributes their own feelings of dislike to others.

Choice D is wrong because, "I have lots of health problems from being obese," is not the correct answer because it is a justification, not a rationalization

The correct answer is Choice C because, "I am relying more and more on my partner for support." The client's response indicates a risk for suicide because it suggests that the client may feel that their partner is the only source of support and may be afraid of being alone. This can contribute to feelings of hopelessness, which are a risk factor for suicide. It is important for the nurse to assess the client's support system and encourage the client to seek additional support if needed.

Choice A is wrong because, "I don't want to lose control of my ability to make decisions," does not indicate a risk for suicide but rather a fear of losing autonomy or control over one's life.

Choice B is wrong because, "I know that everything will be better soon," does not indicate a risk for suicide but rather a hopeful attitude.

Choice D is wrong because, "I am afraid of experiencing pain near the end," does not indicate a risk for suicide but rather a fear of experiencing physical pain or discomfort.

The correct answer is Choice A because, "Organize an influenza immunization clinic with the American Red Cross." The parish nurse group should plan to provide influenza immunization clinics to help prevent the spread of influenza in the congregation. Influenza is a contagious respiratory illness that can be spread by coughing, sneezing, and touching contaminated surfaces. This answer is correct because immunization clinics will help prevent influenza, which is a primary and secondary health care need for the congregation.

Choice B is wrong because is incorrect because providing end-of-life care is not a primary or secondary health care need for the congregation, and the parish nurse group is not qualified to provide this level of care.

Choice C is wrong because is incorrect because performing wound care in the home of members is not a primary or secondary health care need for the congregation.

Choice D is wrong because is incorrect because facilitating discharge from the facility to the home is not a primary or secondary health care need for the congregation.

The correct answer is Choice D because, "Household contacts will receive prophylactic antibiotics." The nurse should include in the teaching that household contacts of the child with pertussis will receive prophylactic antibiotics to prevent the spread of the disease. This answer is correct because pertussis is a highly contagious respiratory illness that spreads through respiratory droplets, and prophylactic antibiotics can help prevent the spread of the disease.

Choice A is wrong because is incorrect because a dehumidifier will not prevent the spread of pertussis.

Choice B is wrong because is incorrect because pertussis does not cause a rash.

Choice C is wrong because is incorrect because herd immunity occurs when a large percentage of the population is immunized against a disease, and pertussis is preventable with vaccination.

The correct answer is Choice C because, "Determine students' motivation to learn about healthy food choices." The nurse should first determine the students' motivation to learn about healthy food choices to tailor the program to their needs. This answer is correct because understanding students' motivation to learn about healthy food choices is essential for designing effective educational programs.

Choice A is wrong because is incorrect because giving positive feedback to students who make appropriate choices is not a starting point for planning the program.

Choice B is wrong because is incorrect because recognizing the value of making healthy food choices is not a starting point for planning the program.

Choice D is wrong because is incorrect because providing students with resources about making wise choices independently is not a starting point for planning the program.

The correct answer is Choice D because, "Release a media announcement asking residents to remove areas of standing water." The nurse should release a media announcement asking residents to remove areas of standing water to prevent the breeding of mosquitos. This answer is correct because standing water provides a breeding ground for mosquitos, which can transmit encephalitis.

Choice Bis wrong because is incorrect because researching the species of mosquito responsible for the outbreak is not an activity that the nurse should perform to implement mosquito control strategies.

Choice Ais wrong because is incorrect because reviewing morbidity rates of encephalitis within the last 6 months is not an activity that the nurse should perform to implement mosquito control strategies.

Choice C is wrong because is incorrect because identifying the number of cases resulting in disability from encephalitis is not an activity that the nurse should perform to implement mosquito control strategies.

The correct answers are Choice B, "I can receive care in the hospital or at home," Choice D, "I will receive care from a variety of interprofessional team members," and choice E, "I can discontinue hospice care whenever I want."

The client who has a terminal illness should understand that hospice care can be provided in the hospital or at home, that a variety of interprofessional team members will provide care, and that they can discontinue hospice care whenever they want. These answers are correct because they demonstrate an accurate understanding of hospice care.

Hospice care can be provided in a variety of settings, including the home or a hospital, and typically involves a team of healthcare professionals, such as doctors, nurses, social workers, and spiritual counselors, who work together to address the physical, emotional, and spiritual needs of the client and their family. Hospice care is focused on comfort and quality of life, rather than curative treatment, and clients can choose to discontinue care at any time.

Choice A is wrong because, "I will need to have private insurance because Medicare does not cover hospice services," is incorrect because Medicare does cover hospice services. Hospice care is a covered benefit under Medicare Part A, and most private insurance plans also cover hospice care.

Choice C is wrong because, "My provider will recommend that I enter hospice care when I have 1 year left to live," is incorrect because there is no set time frame for entering hospice care. Hospice care is appropriate for clients with a life expectancy of six months or less, as determined by their physician, but there is no requirement that clients must have one year left to live before entering hospice care.

The correct answers are B, D, and E because they accurately reflect the nature of hospice care and the options available to clients who are receiving this type of care.

The correct answer is Choice C because, "Refer clients to the appropriate community agency if signs of abuse are evident." This is the correct answer because it is an appropriate secondary prevention strategy related to violence and abuse. By referring clients to the appropriate community agency, the nurse is providing a proactive measure to prevent further harm and ensure that the client receives appropriate care.

Choice Ais wrong because, "Teach a parenting skills class at a child development center," is not the correct answer because it is a primary prevention strategy and not related to violence and abuse.

Choice Bis wrong because, "Assess clients for withdrawal and passivity during home health visits," is not the correct answer because it is a secondary prevention strategy related to depression, not violence and abuse.

Choice Dis wrong because, "Coordinate a personal defense program at a local agency," is not the correct answer because it is a tertiary prevention strategy and not related to violence and abuse.

Answer and explanation

The correct answer is Choice A because, "Conduct a survey to identify the community's need for hypertension screening." This is the correct answer because it is important to determine the need for hypertension screening in the community before implementing a health-screening program.

Choice B is wrong because, "Research best practices for treatment of hypertension," is not the correct answer because it is a step that comes after identifying the need for hypertension screening.

Choice C is wrong because, "Determine the number of clients referred for treatment of hypertension," is not the correct answer because it is a step that comes after hypertension screening has occurred.

Choice D is wrong because, "Apply for funding to conduct hypertension screening," is not the correct answer because it is a step that comes after identifying the need for hypertension screening and developing a plan for the health-screening program.

The correct answer is Choice A because, "Offer to face the client's bed toward the east." This is the correct answer because traditional American Indian practices include spiritual and cultural beliefs that may require facing the client's bed towards the east.

Choice B is wrong because, "Provide direct eye contact when communicating with the client's family," is not the correct answer because direct eye contact may be seen as disrespectful in some American Indian cultures.

Choice C is wrong because, "Develop a list of appropriate hot and cold food choices," is not the correct answer because it is not specific to traditional American Indian practices.

Choice D is wrong because, "Discuss safe use of herbal medications," is not the correct answer because it is not specific to traditional American Indian practices and may be considered invasive or disrespectful in some cultures.

The correct answer is Choice B because, "Teaching parenting techniques to new parents." This is the correct answer because it is a primary prevention strategy aimed at reducing violence and abuse in the local community.

Choice A is wrong because, "Providing treatment for a young adult who has a substance use disorder," is not the correct answer because it is a tertiary prevention strategy aimed at treating an individual after they have developed a substance use disorder.

Choice C is wrong because, "Conducting counseling for at-risk parents," is not the correct answer because it is a secondary prevention strategy aimed at reducing the risk of violence and abuse in families who are at-risk.

Choice D is wrong because, "Assessing a family for marital discord," is not the correct answer because it is a secondary prevention strategy aimed at identifying and addressing issues within a family, but it is not specifically related to violence and abuse.

The correct answer is Choice D because, "State health departments report selected STIs to the National Institutes of Health." This is the correct answer because state health departments are responsible for reporting selected STIs to the National Institutes of Health, which is an important regulation regarding STIs.

Choice A is wrong because, "Clients who have STIs are legally required to provide a list of sexual partners," is

not the correct answer because while clients who have STIs are strongly encouraged to provide a list of sexual partners for partner notification and treatment purposes, there is no legal requirement for them to do so.

Choice B is wrong because, "Congress mandates the requirements for STI reporting," is not the correct answer because STI reporting requirements are set by public health agencies, not by Congress.

Choice C is wrong because, "Nurses should withhold the name of the client who has an STI during partner notification," is not the correct answer because while nurses are required to maintain confidentiality of their clients, they are also obligated to report certain communicable diseases, including STIs, to public health authorities, who may need to conduct partner notification and treatment efforts.

The correct answer is Choice D because, "State health departments report selected STIs to the National Institutes of Health." This statement indicates an understanding of the regulation regarding STI reporting, as state health departments are responsible for reporting selected STIs to the National Institutes of Health.

Choice A is wrong because, "Clients who have STIs are legally required to provide a list of sexual partners," is not correct. While it is important for clients to provide information about their sexual partners to prevent further spread of STIs, it is not a legal requirement.

Choice B is wrong because, "Congress mandates the requirements for STI reporting," is not correct. Congress does not mandate the requirements for STI reporting. It is the responsibility of state health departments to report selected STIs to the National Institutes of Health.

Choice C is wrong because, "Nurses should withhold the name of the client who has an STI during partner notification," is not correct. Nurses should not withhold the name of the client who has an STI during partner notification, as this is an important step in preventing the further spread of STIs.

Explanation: State health departments are responsible for reporting selected STIs to the National Institutes of Health. Clients are not legally required to provide a list of sexual partners, and Congress does not mandate the requirements for STI reporting. Nurses should not withhold the name of the client who has an STI during partner notification.

The correct answer is Choice D because, "Establish a location to perform client triage." During the response phase of a disaster plan, it is important to establish a location to perform client triage, as this allows for the efficient allocation of resources.

Choice A is wrong because, "Create a checklist of needed supplies for each type of disaster," is not the correct answer. While creating a checklist of needed supplies is important in disaster planning, it is not specific to the response phase.

Choice B is wrong because, "Conduct community disaster drills," is not the correct answer. Community disaster drills are an important part of disaster planning, but they are not specific to the response phase.

Choice C is wrong because, "Develop an evacuation plan for the community," is not the correct answer. While developing an evacuation plan is important in disaster planning, it is not specific to the response phase.

Explanation: During the response phase of a disaster plan, it is important to establish a location to perform client triage. Creating a checklist of needed supplies, conducting community disaster drills, and developing an evacuation plan are important in disaster planning but are not specific to the response phase.