Nokea
During preoperative education, a nurse should assess a client's readiness to learn before a mastectomy. Which of the following statements should the nurse identify as an indication that the client is ready to learn?
- A. "I don't want my spouse to see my incision."
- B. "Will you give me pain medicine after the surgery?"
- C. "Can you tell me about how long the surgery will take?"
- D. "My roommate listens to everything I say."
Correct Answer: C
Rationale: The correct answer is C. Asking about the duration of the surgery indicates readiness to learn about the procedure. This question shows that the client is actively seeking information about the surgical process, demonstrating readiness to learn. Choices A, B, and D reflect concerns, specific requests, or statements unrelated to the learning process. They do not directly indicate readiness to absorb information about the upcoming mastectomy.
You may also like to solve these questions
The healthcare provider is caring for a client with a wound infection. Which type of dressing is most appropriate to use to promote healing by secondary intention?
- A. Dry gauze dressing
- B. Wet-to-dry dressing
- C. Transparent film dressing
- D. Hydrocolloid dressing
Correct Answer: D
Rationale: Hydrocolloid dressings are ideal for promoting healing by secondary intention in wound infections. These dressings create a moist environment that supports autolytic debridement and facilitates the healing process. Dry gauze dressings (Option A) may lead to adherence, causing trauma upon removal and disrupting the wound bed. Wet-to-dry dressings (Option B) are primarily used for mechanical debridement and can be painful during dressing changes. Transparent film dressings (Option C) are more suitable for superficial wounds with minimal exudate and are not typically used for wound infections requiring healing by secondary intention.
What should be done when caring for a client who died?
- A. Obtain orders, Remove tubes, Wash client, Ask family, Place tags.
- B. Wash client, Obtain orders, Place tags, Remove tubes, Ask family.
- C. Remove tubes, Obtain orders, Ask family, Place tags, Wash client.
- D. Ask family, Place tags, Wash client, Remove tubes, Obtain orders.
Correct Answer: A
Rationale: When caring for a deceased client, the correct sequence of actions involves first obtaining any necessary orders, then removing tubes, washing the client, asking the family for specific requests, and finally placing identification tags. This order ensures proper care and respect for the deceased individual. Option A presents the correct order of actions. Choice B is incorrect because washing the client should be done after removing tubes. Choice C is incorrect as it does not follow the correct order of actions. Choice D is incorrect because asking the family should be done after caring for the client's body, not before.
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 client requires rectal temperature monitoring, and a nurse has a thermometer with a long, slender tip at the bedside. What is the appropriate action for the nurse to take?
- A. Obtain a thermometer with a short, blunt insertion end
- B. Use the available thermometer as is
- C. Request a new thermometer
- D. Measure the temperature orally instead
Correct Answer: A
Rationale: When monitoring rectal temperature, it is crucial to use a thermometer with a short, blunt insertion end to prevent injury and ensure accurate readings. Using a thermometer with a long, slender tip can pose a risk of perforation or discomfort for the client. Therefore, the appropriate action for the nurse to take is to obtain a thermometer with a short, blunt insertion end. Using the available thermometer as is would not address the safety concerns. Requesting a new thermometer is unnecessary when a suitable one is available by just obtaining it. Measuring the temperature orally instead would not provide the required rectal temperature monitoring.
When providing a bath, in which order will the nurse clean the body, beginning with the first area?
- A. Face
- B. Eyes
- C. Perineum
- D. Back and buttocks
Correct Answer: B
Rationale: The correct sequence for giving a bath starts with cleaning the eyes, followed by the face, both arms, chest, hands/nails, abdomen, both legs, perineal hygiene, back, and finally the buttocks/anus. Therefore, the first area to be cleaned during a bath is the eyes. Choices A, C, and D are incorrect as per the standard procedure for providing a bath.