Nokea
A client with a large goiter is scheduled for a subtotal thyroidectomy to treat thyrotoxicosis. Saturated solution of potassium iodide (SSKI) is prescribed preoperatively for the client. The primary reason for using this drug is that it helps:
- A. Slow progression of exophthalmos.
- B. Reduce the vascularity of the thyroid gland.
- C. Decrease the body's ability to store thyroxine.
- D. Increase the body's ability to excrete thyroxine.
Correct Answer: B
Rationale: SSKI reduces the vascularity of the thyroid gland, making surgery safer by decreasing the risk of bleeding. It does not primarily affect exophthalmos, thyroxine storage, or excretion.
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A 58-year-old client with pancreatic cancer, who has been bed-bound for 3 weeks, has just returned from having a left subclavian, long-term, tunneled catheter inserted for administration of analgesics. The nurse has not yet received radiographic results for confirmation of placement. The client becomes diaphoretic and complains of chest pain radiating to the middle of his back. Physical assessment reveals tachycardia and absent breath sounds in the left lung. The nurse should further assess the client for:
- A. An air embolus.
- B. A pneumothorax.
- C. A pulmonary embolus.
- D. A myocardial infarction.
Correct Answer: B
Rationale: Absent breath sounds, chest pain, and tachycardia post-catheter insertion suggest a pneumothorax, a known complication of subclavian catheter placement, requiring urgent assessment.
The nurse interprets which of the following as an early sign of acute respiratory distress syndrome (ARDS) in a client at risk?
- A. Elevated carbon dioxide level.
- B. Hypoxia not responsive to oxygen therapy.
- C. Metabolic acidosis.
- D. Severe, unexplained electrolyte imbalance.
Correct Answer: B
Rationale: Hypoxia unresponsive to oxygen therapy is an early ARDS sign due to impaired gas exchange. Elevated CO2, metabolic acidosis, and electrolyte imbalances occur later or are unrelated.
A client had a repair of a thoracoabdominal aneurysm 2 days ago. Which of the following findings should the nurse consider unexpected and report to the physician immediately? The client has:
- A. Abdominal pain at 5 on a scale of 0 to 10 for the last 2 days
- B. Heart rate of 100 beats per minute after ambulating 200 feet
- C. Urine output of 2,000 mL in 24 hours
- D. Weakness and numbness in the lower extremities
Correct Answer: D
Rationale: Weakness and numbness in the lower extremities post-thoracoabdominal aneurysm repair suggest spinal cord ischemia or graft-related complications, requiring immediate reporting. Persistent pain, elevated heart rate post-ambulation, and normal urine output are expected or less urgent.
The nurse is preparing the discharge of a client with a metal joint. The nurse should instruct the client about which of the following? Select all that apply.
- A. Notify health care providers about the joint prior to invasive procedures.
- B. Avoid use of Magnetic Resonance Imaging (MRI) scans.
- C. Notify airport security that the joint may set off alarms on metal detectors.
- D. Refrain from carrying items weighing more than 5 lb.
- E. Limit fluid intake to 1,000 mL/day.
Correct Answer: A,C
Rationale: Notifying providers and airport security about the metal joint prevents complications and delays. MRI scans are generally safe with modern prostheses.
Prevention of skin breakdown and maintenance of skin integrity among older clients is important because they are at greater risk secondary to:
- A. Altered balance.
- B. Altered protective pressure sensation.
- C. Impaired hearing ability.
- D. Impaired visual acuity.
Correct Answer: B
Rationale: Older adults have reduced pressure sensation due to thinner skin and nerve changes, increasing the risk of skin breakdown and pressure ulcers.