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| Section | Weight | Objectives |
|---|---|---|
| Physiological Integrity | 43–67% | - Physiological Adaptation - Reduction of Risk Potential - Pharmacological and Parenteral Therapies - Basic Care and Comfort |
| Safe and Effective Care Environment | 17–33% | - Management of Care - Safety and Infection Control |
| Health Promotion and Maintenance | 6–12% | |
| Psychosocial Integrity | 6–12% |
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NEW QUESTION # 825
A client is having a pneumonectomy done today, and the nurse is planning her postoperative care. Nursing interventions for a postoperative left pneumonectomy would include:
Answer: D
Explanation:
Explanation/Reference:
Explanation:
(A) Chest tubes are usually not necessary in a pneumonectomy because there is no lung to re-expand on the operative side. (B) The pneumonectomy client should be positioned on the back or operated side because the sutured bronchial stump may open, allowing fluid to drain into the unoperated side and drown the client. (C) The client should not have a pillow under the shoulder and back because of the subscapular incision. (D) Rales are commonly heard over the base of the remaining lung, but an increase could indicate circulatory overload and therefore should be closely monitored.
NEW QUESTION # 826
A client is to be discharged from the hospital and is to continue taking warfarin 2.5 mg po bid. Which of the following should be included in her discharge teaching concerning the warfarin therapy?
Answer: D
Explanation:
Explanation/Reference:
Explanation:
(A) Warfarin must always be taken exactly as directed. Clients should be instructed never to skip or double up on their dosage. (B) Aspirin decreases platelet aggregation, which would potentiate the effects of the coumadin. (C) Healthcare providers need to be aware of persons on warfarin therapy prior to the initiation of any diagnostic tests and/or surgery to help prevent bleeding complications. (D) An electric razor should be used to prevent accidental cutting, which can lead to bleeding.
NEW QUESTION # 827
When interviewing parents who are suspected of child abuse, the nurse would use which of the following interview techniques?
Answer: B
Explanation:
Section: Questions Set E
Explanation/Reference:
Explanation:
(A) The nurse must be honest, direct, professional, and attentive in her interview to gain the parent's trust. (B) The nurse should approach the parents in private, away from the child. (C) Asking them to relive and evaluate the situation may be looked at as placing blame on the parents for the child's "accident." At this point, the parents may get defensive and stop communicating. (D) Although you may call child protective services, the nurse should inform the parents of their responsibility to do this and explain the process to them.
NEW QUESTION # 828
A client is scheduled for a magnetic resonance imaging (MRI) to locate a cerebral lesion. It is important for the nurse to find out if he has a(n):
Answer: D
Explanation:
Explanation/Reference:
Explanation:
(A) Iodine is not used as a contrast medium for MRI. It is important to inquire about allergy to seafood if the client is to have an arteriogram or enhanced computer tomography. (B) MRI is safe if seizures are under control. It is more important to inquire about movable metal implants. (C) Clients with movable metal implants such as shrapnel or aneurysm clips or clients with permanent pacemakers or implanted pumps can be traumatized during an MRI. (D) Nonmovable metal prostheses or hardware will not cause trauma during an MRI.
NEW QUESTION # 829
Which of the following signs might indicate a complication during the labor process with vertex presentation?
Answer: B
Explanation:
Explanation/Reference:
Explanation:
(A) Fetal tachycardia may indicate fetal hypoxia; however, 170 bpm is only mild tachycardia. (B) Nausea and vomiting occur frequently during transition and are not a complication. (C) Contractions frequently last
60-90 seconds during the transitional phase of labor and are not considered a complication as long as the uterus relaxes completely between contractions. (D) Passage of meconium in a vertex presentation is a sign of fetal distress; this may be normal in a breech presentation owing to pressure on the presenting part.
NEW QUESTION # 830
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