Nokea
The nurse is having difficulty locating a vein, to start intravenous therapy, on a client who is dark-skinned. Which of these devices or procedures may be of benefit to you at this time?
- A. A doppler
- B. A surgical vein cut down
- C. A transillumination device
- D. A sonography
Correct Answer: C
Rationale: A transillumination device uses light to visualize veins, aiding IV insertion in clients with dark skin or poor vein visibility. Doppler assesses blood flow, surgical cutdown is invasive, and sonography is not typically used for peripheral IVs.
You may also like to solve these questions
The patient is experiencing post-operative tachycardia with low blood pressure. The nurse should be most concerned about which of the following surgical complications?
- A. The development of an infection
- B. Hemorrhage
- C. Wound dehiscence
- D. Hematoma
Correct Answer: B
Rationale: Tachycardia with low blood pressure suggests hemorrhage, a life-threatening complication requiring immediate attention. Infection, dehiscence, and hematoma are less acute.
The nurse is teaching a group of students about medications and fall prevention. The nurse would be correct in identifying which of the following medications can increase the risk for falls? Select all that apply.
- A. naproxen
- B. alprazolam
- C. bumetanide
- D. verapamil
- E. allopurinol
- F. thiamine
Correct Answer: B,C,D
Rationale: Alprazolam (benzodiazepine) causes sedation and dizziness, bumetanide (diuretic) can cause orthostatic hypotension, and verapamil (calcium channel blocker) can cause hypotension, all increasing fall risk. Naproxen, allopurinol, and thiamine do not significantly contribute to falls.
The nurse is caring for a client immediately postoperative following a below-the-knee amputation. The nurse should take which priority action?
- A. Elevate the stump on a pillow
- B. Check the operative site for bleeding
- C. Obtain an order for a physical therapy order
- D. Demonstrate the use of incentive spirometry (IS)
Correct Answer: B
Rationale: Checking the operative site for bleeding is the priority to detect hemorrhage, a life-threatening complication in the immediate postoperative period. Elevating the stump may be contraindicated to prevent contractures, physical therapy orders are not immediate, and incentive spirometry, while important, is secondary to hemorrhage control.
The nurse is educating the parents of a child who plans on riding their bicycle. Which statements, if made by the parents, indicate effective understanding?
- A. I should tell my child to ride their bike against the traffic pattern.
- B. I should instruct my child to walk their bike through busy intersection crosswalks.
- C. Wearing a helmet is only necessary when my child is riding near a busy intersection.
- D. My child can ride their bike barefoot as long as it's short distances.
Correct Answer: B
Rationale: Walking the bike through busy intersections enhances safety. Riding against traffic, optional helmet use, and barefoot riding are unsafe.
The charge nurse is observing infection control practices in the nursing unit. Which observation by the charge nurse requires follow-up? Select all that apply.
- A. Soiled linens are placed on the floor during a bed bath and linen change.
- B. A disposable blood pressure cuff is used for a client on contact precautions.
- C. Disposable dishes are placed in the room for a client on droplet precautions.
- D. Reusable eye protection is cleaned and disinfected after each client encounter.
- E. A surgical hand scrub is performed with the hands lower than the elbows.
- F. Gloves are doffed last while removing personal protective equipment (PPE).
Correct Answer: A,E,F
Rationale: Soiled linens on the floor risk contamination, hands should be higher than elbows during surgical scrub, and gloves should be doffed first to prevent contamination.