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A client who is 5'5" tall and weighs 200 pounds is scheduled for surgery the next day. What question is most important for the LPN to include during the preoperative assessment?
- A. What is your daily calorie consumption?
- B. What vitamin and mineral supplements do you take?
- C. Do you feel that you are overweight?
- D. Will a clear liquid diet be okay after surgery?
Correct Answer: B
Rationale: During the preoperative assessment, it is crucial for the LPN to inquire about the client's intake of vitamin and mineral supplements. This is important because certain supplements can have effects on coagulation, wound healing, and overall surgical outcomes. Asking about daily calorie consumption (Choice A) is not as pertinent as inquiring about vitamin and mineral supplements in this context. Questioning the client about feeling overweight (Choice C) may not directly impact the surgical outcome compared to the effects of supplements. Inquiring about the post-surgery diet (Choice D) is relevant but not as critical as understanding the client's supplement intake.
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A client has a new prescription for a home oxygen concentrator. Which of the following instructions should the nurse provide to the client and their family?
- A. Check the cord routinely for frays or tearing
- B. Use oxygen around open flames
- C. Store oxygen concentrator in a closet
- D. Wear synthetic clothing to prevent static electricity
Correct Answer: A
Rationale: The correct answer is to instruct the client and their family to check the cord routinely for frays or tearing. This is crucial to ensure the safety and proper function of the oxygen concentrator. Choice B is incorrect because oxygen should never be used around open flames due to the risk of fire. Choice C is also incorrect as oxygen cylinders or concentrators should not be stored in a closet due to ventilation and safety concerns. Choice D is incorrect because synthetic clothing can generate static electricity, which could pose a risk around oxygen equipment.
A nurse is providing care to a client who has an indwelling urinary catheter. Which of the following actions should the nurse take to prevent catheter-associated urinary tract infections (CAUTIs)?
- A. Irrigate the catheter with sterile water daily.
- B. Empty the catheter bag every 8 hours.
- C. Clean the perineal area with antiseptic solution daily.
- D. Secure the catheter to the client's thigh.
Correct Answer: D
Rationale: Securing the catheter to the client's thigh is the correct action to prevent CAUTIs. By securing the catheter, movement is minimized, reducing the risk of introducing bacteria into the urinary tract. Choice A is incorrect because routine irrigation of the catheter is not recommended as it can increase the risk of infection. Choice B is incorrect as emptying the catheter bag every 8 hours is important for proper drainage but does not directly prevent CAUTIs. Choice C is incorrect because cleaning the perineal area with antiseptic solution does not address the main source of CAUTIs related to catheter care.
The nurse has admitted a 4-year-old with the diagnosis of possible rheumatic fever. Which statement by the parent would cause the nurse to suspect an association with this disease?
- A. Our child had chickenpox 6 months ago.
- B. Strep throat went through all the children at the day care last month.
- C. Both ears were infected over 3 months ago.
- D. Last week both feet had a fungal skin infection.
Correct Answer: B
Rationale: The correct answer is B. Rheumatic fever often follows a strep throat infection, which is why the nurse should suspect this association. Strep throat is caused by Group A Streptococcus bacteria, which can trigger an abnormal immune response leading to rheumatic fever. Choices A, C, and D are incorrect because chickenpox, ear infections, and fungal skin infections are not typically associated with rheumatic fever.
A client is being taught how to use an incentive spirometer. Which of the following statements by the client indicates an understanding of the teaching?
- A. I will try to seal my lips around the mouthpiece
- B. I will use the spirometer as needed throughout the day
- C. I will inhale slowly and deeply when using the spirometer
- D. I will seal my lips around the mouthpiece
Correct Answer: D
Rationale: The correct answer is D. Sealing the lips around the mouthpiece is crucial for the proper use of an incentive spirometer as it helps ensure effective delivery of the inhaled medication. Choice A has been corrected to reflect the importance of sealing the lips. Choices B and C are incorrect because using the spirometer as needed throughout the day and inhaling slowly and deeply, although beneficial, do not directly address the essential technique of sealing the lips around the mouthpiece.
A healthcare professional is planning to perform ear irrigation on an adult client with impacted cerumen. Which of the following should the professional plan to take?
- A. Wearing sterile gloves while performing irrigation
- B. Positioning the client with the affected side down following irrigation
- C. Using cool fluid to irrigate the ear canal
- D. Pulling the pinna downward during irrigation
Correct Answer: B
Rationale: Positioning the client with the affected side down following irrigation is crucial as it helps facilitate drainage of the dislodged cerumen and any remaining irrigation solution. This position allows gravity to assist in the removal of the loosened debris. Wearing sterile gloves is a standard precaution in healthcare procedures to prevent infection but is not specific to ear irrigation. Using body-temperature water or a solution at a slightly warmer temperature is recommended to prevent vertigo and discomfort, so using cool fluid is incorrect. Pulling the pinna upward and backward, not downward, straightens the ear canal for adults to facilitate the irrigation process, making choice D incorrect.