Nokea
The client with a cataract tells the nurse that she is afraid of being awake during eye surgery. Which of the following responses by the nurse would be the most appropriate?
- A. Have you ever had any reactions to local anesthetics in the past?
- B. What is it that disturbs you about the idea of being awake?
- C. With a local anesthetic, you won't have nausea and vomiting after the surgery.
- D. There's really nothing to fear about being awake. You'll be given a medication that will help you relax.
Correct Answer: B
Rationale: The nurse should give a client who seems fearful of surgery an opportunity to express her feelings. Only after identifying the client's concerns can the nurse address them appropriately. Asking about previous reactions to anesthetics or discussing nausea does not address the client's fear. Minimizing the client's feelings by saying there is nothing to fear ignores her concerns.
You may also like to solve these questions
A nurse is caring for a client with lung cancer who develops syndrome of inappropriate antidiuretic hormone (SIADH). Which laboratory finding should the nurse expect?
- A. Serum sodium of 128 mEq/L.
- B. Serum potassium of 5.5 mEq/L.
- C. Serum calcium of 11.0 mg/dL.
- D. Serum glucose of 200 mg/dL.
Correct Answer: A
Rationale: SIADH causes water retention, diluting serum sodium, so a low sodium level (128 mEq/L) is expected due to the inappropriate secretion of antidiuretic hormone.
The client who does not respond adequately to fluid replacement has an order for an I.V. infusion of dopamine hydrochloride at 5 µg/kg/minute. To determine that the drug is having the desired effect, the nurse should assess the client for:
- A. Increased renal and mesenteric blood flow.
- B. Increased cardiac output.
- C. Vasoconstriction.
- D. Reduced preload and afterload.
Correct Answer: B
Rationale: Dopamine at 5 µg/kg/minute primarily increases cardiac output by enhancing myocardial contractility and heart rate, improving perfusion in shock. Renal/mesenteric flow occurs at lower doses, vasoconstriction at higher doses, and preload/afterload reduction is not a primary effect.
A small airplane crashes in a neighborhood of 10 houses. One of the victims appears to have a cervical spine injury. What should first-aid for this victim should be selected that apply.
- A. Establish an airway with the jaw-thrust maneuver.
- B. Immobilize the spine.
- C. Logroll the victim to a side-lying position.
- D. Elevate the feet 6" (15.2 cm).
- E. Place a cervical collar around the neck.
Correct Answer: A,B,E
Rationale: For a suspected cervical spine injury, the airway should be opened with the jaw-thrust maneuver, the spine immobilized, and a cervical collar applied to prevent further injury. Logrolling or elevating feet could exacerbate the injury.
A client arrives from surgery to the postanesthesia care unit. Which of the following respiratory assessments should the nurse complete first?
- A. Oxygen saturation.
- B. Respiratory rate.
- C. Breath sounds.
- D. Airway flow.
Correct Answer: A
Rationale: Oxygen saturation is the first respiratory assessment in the PACU, as it quickly indicates oxygenation status and guides further interventions if hypoxia is detected.
The nurse is teaching a client with osteoarthritis about assistive devices. Which device is most appropriate for ambulation?
- A. Standard cane.
- B. Wheelchair.
- C. Four-wheeled walker.
- D. Crutches.
Correct Answer: A
Rationale: A standard cane provides support and stability for clients with osteoarthritis during ambulation.