Nokea
The nurse provides discharge instructions for a client who has recovered after a cardiac catheterization. Which instructions should be included? Select all that apply.
- A. Take a shower rather than a tub bath until the puncture site heals.
- B. Perform leg exercises every 2 hours while awake.
- C. In the generous amount of fluids for the next 24 hours.
- D. Report worsening of pain in the leg that was catheterized.
- E. Flush the toilet twice after eliminating urine and stool in the next 24 hours.
- F. Change the dressing over the puncture site daily until it heals.
Correct Answer: A,C,D
Rationale: Showering prevents infection, generous fluids help flush contrast dye, and reporting worsening pain detects complications. Leg exercises, double flushing, and daily dressing changes are not standard.
You may also like to solve these questions
Which assessment finding offers the best evidence that the client can tolerate the activity involved in getting out of bed?
- A. The client's appetite has improved.
- B. The client reports a more restful sleep.
- C. The client's heart rate is stable.
- D. The client can get out of bed without assistance.
Correct Answer: C
Rationale: Stable heart rate indicates the heart can handle the increased demand of activity.
An adult client is admitted to the hospital with peripheral vascular disease of the lower extremities. He has several ischemic ulcers on each ankle and lower leg area. Other parts of his skin are shiny and taut with loss of hair. A primary nursing goal for this client should be to do which of the following?
- A. Increase activity tolerance
- B. Relieve anxiety
- C. Protect from injury
- D. Help build a positive body image
Correct Answer: C
Rationale: Protecting from injury is critical for a client with peripheral vascular disease and ischemic ulcers to prevent infection and further tissue damage. Other goals are secondary.
The nurse assumes that the client understands how an echocardiogram is performed when that client tells the nurse that this examination involves imaging the heart using which of one of the following?
- A. Ultrasound waves
- B. X-ray beams
- C. Radioactive isotopes
- D. Magnetic fields
Correct Answer: A
Rationale: An echocardiogram uses ultrasound waves to create images of the heart's structure and function.
During cardiopulmonary resuscitation (CPR), the nurse compresses the chest of an adult victim at which rate?
- A. No less than 15 compressions per minute
- B. No less than 40 compressions per minute
- C. No less than 80 compressions per minute
- D. No less than 100 compressions per minute
Correct Answer: D
Rationale: Adult CPR requires 100-120 compressions per minute to restore circulation effectively.
The nurse understands that the client's hesitation in going to the hospital is an example of which coping mechanism?
- A. Regression
- B. Projection
- C. Denial
- D. Undoing
Correct Answer: C
Rationale: Denial involves minimizing or ignoring symptoms, such as attributing chest pain to muscle strain, delaying medical care.