Nokea
Postoperative nursing management of the client following a radical neck dissection for laryngeal cancer requires:
- A. Complete bed rest minimizing head movement.
- B. Vital signs once a shift.
- C. A. All the nurse should be made to be removed at 48 hours.
- D. Frequent suctioning of the laryngectomy tube.
Correct Answer: D
Rationale: Frequent suctioning of the laryngectomy tube prevents mucus buildup and maintains airway patency. Complete bed rest is unnecessary; early mobility is encouraged. Vital signs should be monitored more frequently than once per shift. The third option is unclear but likely incorrect.
You may also like to solve these questions
The client with gastroesophageal reflux disease (GERD) complains of a chronic cough. The nurse understands that in a client with GERD this symptom is indicative of which of the following conditions?
- A. Development of laryngeal cancer.
- B. Irritation of the esophagus.
- C. Esophageal scar tissue formation.
- D. Aspiration of gastric contents.
Correct Answer: D
Rationale: A chronic cough in GERD is often due to aspiration of gastric contents into the respiratory tract, irritating the airways. The other options are less directly related to this symptom.
The nurse caring for a client who is receiving radiation therapy for laryngeal cancer should assess the client for which of the following?
- A. Diarrhea.
- B. Improved energy level.
- C. Dysphagia.
- D. Normal white blood cell count.
Correct Answer: C
Rationale: Dysphagia (difficulty swallowing) is a common side effect of laryngeal radiation due to inflammation and irritation of the throat and esophagus.
The nurse identifies deficient knowledge when the client undergoing induction therapy for leukemia makes which of the following statements?
- A. I will have to pace my activities with rest periods.'
- B. I can't wait to get home to my cat!'
- C. I will use warm saline gargle instead of brushing my teeth.'
- D. I must report a temperature of 100°F.'
Correct Answer: B
Rationale: During leukemia induction therapy, the client is at high risk for infection due to neutropenia. Pets like cats can carry pathogens (e.g., Toxoplasma), and the statement about returning to a cat indicates a knowledge deficit about infection risks. The other statements reflect appropriate self-care measures.
Which of the following nursing interventions is likely to provide the most relief from the pain associated with renal colic?
- A. Applying moist heat to the flank area.
- B. Administering meperidine (Demerol).
- C. Encouraging high fluid intake.
- D. Maintaining complete bed rest.
Correct Answer: B
Rationale: Meperidine, an opioid, provides the most effective relief for the severe pain of renal colic by directly addressing pain pathways.
When instructing a client who has been newly diagnosed with vasospastic disorder (Raynaud's phenomenon) about management of care, the nurse should discuss which of the following topics?
- A. Scheduling a sympathectomy procedure for the next visit
- B. Using a beta blocker medication
- C. Follow-up monitoring for development of connective tissue disease
- D. Benefit of an angioplasty to the affected extremities
Correct Answer: C
Rationale: Raynaud's phenomenon is often associated with connective tissue diseases (e.g., scleroderma, lupus), especially secondary Raynaud's. Discussing follow-up monitoring for these conditions is essential for early detection and management. Sympathectomy, beta blockers, and angioplasty are not first-line or relevant interventions.