A nurse is caring for a client who is 2 days postoperative following a below-the-knee amputation and asks about the purpose of maintaining an elastic bandage around the residual limb of the extremity. Which of the following is an appropriate response by the nurse?
a. "the elastic bandage will prev...
A nurse is caring for a client who is 2 days postoperative following a below-the-knee amputation and
asks about the purpose of maintaining an elastic bandage around the residual limb of the extremity.
Which of the following is an appropriate response by the nurse?
a. "the elastic bandage will prevent a post-op wound infection"
b. "the elastic bandage will prevent excessive edema"
c. "the elastic bandage will keep the sutures from loosening"
d. "the elastic bandage will keep you from seeing the surgical site" - Answer--b. "the elastic bandage
will prevent excessive edema"
A nurse is planning care for a client who is 8 hour post-op following a coronary artery bypass
grafting. Which of the following assessments should the nurse plan to perform first?
, a. Examine the surgical incision for drainage
b. Auscultate breath sounds
c. Palpate pulses distal to the graft donor site
d. Measure the client's core body temperature - Answer--b. Auscultate breath sounds
A nurse in an emergency department is preparing to perform an ocular irrigation for a client. Which
of the following actions should the nurse plan to take?
a. Assess the client's visual acuity prior to irrigation
b. Have the client turn their head toward the unaffected eye
c. Hold the irrigator syringe 3.81 cm (1.5 in) above the eye
d. Perform the irrigation with sterile water for irrigation - Answer--d. Perform the irrigation with
sterile water for irrigation
A nurse is providing discharge teaching to an older adult client following a left total hip arthroplasty.
Which of the following instructions should the nurse include in the teaching?
a. Clean the incision daily with hydrogen peroxide
, b. You can cross your legs the ankles when sitting down
c. You should use an incentive spirometer every 8 hours
d. Install a raised toilet seat in your bathroom - Answer--d. Install a raised toilet seat in your
bathroom
A nurse is planning care for a client following a cardiac catheterization. Which of the following
actions should the nurse take?
a. Keep the client on bed rest for 24 hours
b. Limit the client's fluid intake to 1 l per day
c. Maintain the client's affected extremity in extension
d. Change the client's dressing every 8 hour - Answer--c. Maintain the client's affected extremity in
extension
A nurse is caring for a client who has a lower extremity fracture and a prescription for crutches.
Which of the following client statements indicates that the client is adapting to their role change?
a. I will need to have my partner take over shopping for groceries and cooking the meals for us
b. These crutches will make it impossible to care for my child
c. I feel bad that I have to ask my partner to keep the house clean
, d. Its going to be difficult to tell my parents I cant take them to their appointments anymore -
Answer--a. I will need to have my partner take over shopping for groceries and cooking the meals for us
A nurse is caring for a client who has gastroenteritis. Which of the following assessment findings
should the nurse recognize as an indication that the client is experiencing dehydration?
a. Pitting, dependent edema
b. Distended jugular veins
c. Increased BP
d. Decreased BP - Answer--d. Decreased BP
A nurse is caring for a client who has a contusion of the brainstem and reports thirst. The client's
urinary output was 4,000 ml over the past 24 hour. The nurse should anticipate a prescription for which
of the following IV medication?
a. Desmopressin
b. Epinephrine
c. Furosemide
d. Nitroprusside - Answer--a. Desmopressin
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