Nokea
A client has returned to the medical-surgical unit after a cardiac catheterization. Which is the most important initial postprocedure nursing assessment for this client?
- A. Monitor the laboratory values.
- B. Observe neurologic function every 15 minutes.
- C. Observe the puncture site for swelling and bleeding.
- D. Monitor skin warmth and turgor.
Correct Answer: C
Rationale: Observing the puncture site for swelling and bleeding is critical post-catheterization to detect complications like hematoma or hemorrhage.
You may also like to solve these questions
The development of a culturally sensitive health education program for the socioeconomically disadvantaged requires the nurse to:
- A. Locate the program at an existing government facility.
- B. Integrate folk beliefs and traditions into the content.
- C. Prepare materials in the primary language of the program sponsor.
- D. Exclude community leaders from initial planning efforts.
Correct Answer: B
Rationale: Integrating folk beliefs and traditions ensures the program is culturally relevant and increases acceptance and effectiveness among socioeconomically disadvantaged populations.
Galactorrhea is caused by overproduction of which hormone?
- A. Prolactin.
- B. Adrenocorticotropic hormone (ACTH).
- C. Growth hormone (GH).
- D. Thyroid-stimulating hormone (TSH).
Correct Answer: A
Rationale: Galactorrhea (inappropriate breast milk production) is caused by excess prolactin, often due to a prolactin-secreting pituitary adenoma.
A client arrives from surgery to the postanesthesia care unit. Which of the following respiratory assessments should the nurse complete first?
- A. Oxygen saturation.
- B. Respiratory rate.
- C. Breath sounds.
- D. Airway flow.
Correct Answer: A
Rationale: Oxygen saturation is the first respiratory assessment in the PACU, as it quickly indicates oxygenation status and guides further interventions if hypoxia is detected.
Which of the following represents the most appropriate nursing intervention for a client with pruritus caused by cancer or the treatment?
- A. Administration of antihistamines.
- B. Steroids.
- C. Silk sheets.
- D. Medicated cool baths.
Correct Answer: D
Rationale: Medicated cool baths soothe the skin and reduce pruritus, a common symptom in cancer patients, without the systemic effects of antihistamines or steroids.
The client with cirrhosis receives 100 mL of 25% serum albumin I.V. Which finding would best indicate that the albumin is having its desired effect?
- A. Increased urine output.
- B. Increased serum albumin level.
- C. Decreased anorexia.
- D. Increased ease of breathing.
Correct Answer: D
Rationale: Albumin increases oncotic pressure, reducing ascites and improving respiratory function. Increased ease of breathing (D) indicates effectiveness. Urine output (A), serum albumin (B), and anorexia (C) are less direct indicators.