Nokea
Four days after surgery for internal fixation of a C3 to C4 fracture, a nurse is moving a client from the bed to the wheelchair. The nurse is checking the wheelchair for correct features for this client. Which of the following features of the wheelchair are appropriate for the needs of this client?
- A. Back at the level of the client's scapula.
- B. Back and head that are high.
- C. Seat that is lower than normal.
- D. Seat with firm cushions.
- E. Chair controlled by client's breath.
Correct Answer: B,D,E
Rationale: A high back and headrest provide neck stability, firm cushions prevent pressure ulcers, and a breath-controlled chair accommodates limited upper extremity function post-C3-C4 injury. A low back or lower seat height could compromise stability or transfer safety.
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Which of the following reasons explains why meperidine (Demerol) is not recommended for chronic cancer-related pain?
- A. It has a high potential for abuse.
- B. It has agonist-antagonist properties.
- C. It must be given intramuscularly to be effective.
- D. It contains a metabolite that causes seizures.
Correct Answer: D
Rationale: Meperidine's metabolite, normeperidine, accumulates with repeated dosing and can cause seizures, making it unsuitable for chronic cancer pain.
The nurse devises a teaching plan for the client with aplastic anemia. Which of the following is the most important concept to teach for health promotion and maintenance?
- A. Eat animal protein and dark green, leafy vegetables and eggs.
- B. Avoid exposure to others with acute infections.
- C. Practice yoga and meditation to decrease stress and anxiety.
- D. Get 8 hours of sleep at night and take naps during the day.
Correct Answer: B
Rationale: Aplastic anemia is characterized by bone marrow failure, leading to low blood cell counts and increased risk of infection due to neutropenia. The most important health promotion strategy is to avoid exposure to infections, as infections can be life-threatening in these clients. While nutrition, stress management, and sleep are important, infection prevention is the priority.
A nurse is instructing a client who had abdominal surgery that day to do deep-breathing exercises. In which order should the nurse teach the client to perform diaphragmatic breathing and coughing?
- A. Inhale through the nose.
- B. Cough deeply from the lungs.
- C. Exhale through pursed lips.
- D. Splint the incisional site.
Correct Answer: D,A,C,B
Rationale: The correct order is: splint the incision (D) to reduce pain, inhale through the nose (A) to expand lungs, exhale through pursed lips (C) to control breathing, and cough deeply (B) to clear secretions.
An 80-year-old client had spinal anesthesia for a transurethral resection of the prostate and received 4,000 mL of room temperature isotonic bladder irrigation. He now has continuous irrigation through a three-way indwelling urinary catheter. Which postoperative nursing intervention is most important to include in his plan of care?
- A. Empty the catheter drainage bag.
- B. Cover the client with warm blankets.
- C. Hang new bags of irrigation.
- D. Turn the client.
Correct Answer: B
Rationale: Room-temperature irrigation can cause hypothermia, especially in an elderly client. Covering with warm blankets is the most important intervention to maintain normothermia.
After surgery for an ileal conduit, the nurse should closely assess the client for the occurrence of which of the following complications related to pelvic surgery?
- A. Peritonitis.
- B. Thrombophlebitis.
- C. Ingestes.
- D. Inguinal hernia.
Correct Answer: A,B
Rationale: Peritonitis and thrombophlebitis are significant complications of pelvic surgery like an ileal conduit, due to potential infection or vascular issues. 'Ingestes' appears to be a typo and is not a recognized complication.