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What is the rationale for using preoperative checklists on the day of surgery?
- A. The patient is correctly identified.
- B. All preoperative orders and procedures have been carried out and records are complete.
- C. Patients' families have been informed as to where they can accompany and wait for patients.
- D. Preoperative medications are the last procedure before the patient is transported to the operating room.
Correct Answer: B
Rationale: Checklists ensure all necessary steps are completed, enhancing patient safety.
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What is the term used for assessment data that the patient tells you about?
- A. Focused
- B. Objective
- C. Subjective
- D. Comprehensive
Correct Answer: C
Rationale: The correct answer is 'Subjective.' Subjective data includes patient-reported symptoms, feelings, and experiences.
What is the primary treatment for retinal detachment?
- A. Laser photocoagulation
- B. Cryotherapy
- C. Surgery
- D. All of the above
Correct Answer: D
Rationale: Retinal detachment requires prompt surgical intervention to reattach the retina and preserve vision.
Total parenteral nutrition(TPN), is one of the home therapies being used for Chelsea Mann, 35, with acute ulcerative colitis causing massive diarrhea. She and her family will need instruction about:
- A. caring for the central catheter.
- B. how to mix the TPN solution.
- C. fixing malfunctions occuring in the IV pump.
- D. teaching the neighbors how to care for her.
Correct Answer: A
Rationale: Prevention of infection, and potential septicemia, is of prime importance for someone with a central catheter. Mixing TPN is a very specialized procedure, and should be done under laminar airflow by a pharmacist. IV pumps are machines that do malfunction, but the safest thing to do would be to get the manufacturer to do the repair. Having neighbors be a support to Chelsea and her family may not be possible. More information would be necessary prior to choosing this as an option for a nursing diagnosis.
Following a gastric resection, a 70-year-old male client is admitted to the Post-Anesthesia Care Unit (PACU). The client was extubated prior to leaving the OR suite. Upon arrival at the PACU, the nurse should first:
- A. check the client's airway to feel for the amount of air exchange, noting the rate, depth, and quality of respirations.
- B. obtain pulse and blood pressure readings, noting the rate and quality of the client's pulse.
- C. reassure the client that his surgery is over and that he is in the recovery room.
- D. review the doctor's orders to administer any medications ordered.
Correct Answer: A
Rationale: Adequate air exchange and tissue oxygenation depends upon competent respiratory function. Checking the airway is the nurse's priority action. Obtaining the vital signs is an important action, but is secondary to airway management. Re-orienting a client to time, place, and person and knowing that their surgery is over is important, but is secondary to airway management and taking vital signs. Airway management takes precedence over the physician's orders, unless the orders specifically relate to airway management.
What outcome of being truthful about a terminal illness enhances the nurse-client relationship?
- A. The client’s autonomy and right to determine how to spend the rest of their life is upheld.
- B. Meaningful communication between clients and family members is promoted.
- C. The nurse-client relationship is based on honesty rather than false pretenses.
- D. Clients can use inner resources and determination to survive and prolong life.
Correct Answer: A
Rationale: Truthfulness empowers clients to make informed decisions about their remaining time, reinforcing trust and respect.