Which instructions would the nurse provide to the client about the prevention and early detection of Lyme disease? Select all that apply.
Avoid the use of insect repellent on the skin and clothing because of its toxicity.
Avoid heavily wooded areas and areas with thick underbrush.
Wear dark clothing when walking in wooded areas.
Wear long-sleeved tops and long pants with closed shoes.
If a tick is found, report to the primary health care provider immediately for a blood test to detect the presence of Lyme disease.
Bathe after being in an infested area and inspect the body carefully for ticks.
Correct Answer : B,D,F
Choice A rationale
Avoiding the use of insect repellent on the skin and clothing is not recommended. Insect repellents containing DEET are effective in preventing tick bites, which can transmit Lyme disease. The toxicity of DEET is minimal when used as directed.
Choice B rationale
Avoiding heavily wooded areas and areas with thick underbrush is recommended to reduce the risk of tick exposure. Ticks that carry Lyme disease are commonly found in these environments.
Choice C rationale
Wearing dark clothing is not recommended as it makes it harder to spot ticks. Light-colored clothing is preferable as it allows for easier detection of ticks.
Choice D rationale
Wearing long-sleeved tops and long pants with closed shoes is recommended to minimize skin exposure and reduce the risk of tick bites.
Choice E rationale
Reporting to the primary health care provider immediately for a blood test if a tick is found is not necessary. The presence of a tick does not immediately indicate Lyme disease. Instead, the tick should be removed promptly, and the area should be monitored for signs of infection.
Choice F rationale
Bathing after being in an infested area and inspecting the body carefully for ticks is recommended. This helps in early detection and removal of ticks, reducing the risk of Lyme disease.
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Correct Answer is C
Explanation
Choice A rationale
Applying cool compresses can help reduce swelling and discomfort, but it is not the primary instruction for a client scheduled for retinal detachment surgery.
Choice B rationale
Eye drops to constrict the pupils are not typically prescribed for retinal detachment surgery. The focus is on preventing further detachment and ensuring proper healing.
Choice C rationale
Restricting head movement is crucial to prevent further detachment of the retina and to promote proper healing after surgery. The client should be instructed to avoid sudden or excessive head movements.
Choice D rationale
Keeping both eyes patched is not necessary and may cause unnecessary discomfort and disorientation for the client.
Correct Answer is C
Explanation
Choice A rationale
Pitting edema of the hands and fingers is not a typical finding in clients with systemic lupus erythematosus (SLE). Edema can occur in SLE, but it is more commonly associated with renal involvement and not specifically pitting edema of the hands and fingers.
Choice B rationale
Subcutaneous nodules on the ulnar side of the arm are more commonly associated with rheumatoid arthritis rather than SLE. SLE does not typically present with subcutaneous nodules.
Choice C rationale
A dry, red rash across the bridge of the nose and on the cheeks, known as a “butterfly rash,” is a classic sign of SLE. This rash is caused by inflammation of the small blood vessels in the skin and is often exacerbated by sun exposure.
Choice D rationale
A grey-colored, non-purpuric papular rash is not characteristic of SLE. The typical rash in SLE is the butterfly rash, which is dry, red, and raised.