A nurse is assisting with the care of a client who has a chest tube in place following a thoracotomy. Which of the following actions should the nurse take?

Empty the drainage container every 4 hr.

Change the client's insertion-site dressing each shift.

Clamp the chest tube when the client is ambulating.

Place the drainage unit below the client's chest level.

Answer and Explanation

The Correct Answer is D

Choice A reason: This is an incorrect action, because emptying the drainage container every 4 hr is not necessary and can interfere with the accurate measurement of the drainage volume. The drainage container should be emptied only when it is full or at the end of the shift.

Choice B reason: This is an incorrect action, because changing the client's insertion-site dressing each shift can increase the risk of infection and dislodgment of the chest tube. The insertion-site dressing should be changed only when it is soiled or loose.

Choice C reason: This is an incorrect action, because clamping the chest tube when the client is ambulating can cause a tension pneumothorax, which is a life-threatening complication of chest tube insertion. The chest tube should be clamped only when ordered by the provider or when changing the drainage system.

Choice D reason: This is the correct action, because placing the drainage unit below the client's chest level can facilitate the drainage of air and fluid from the pleural space by gravity. The drainage unit should be kept below the client's chest level at all times.

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Correct Answer is C

Explanation

Choice A reason: This is an incorrect instruction, because the client does not need to remain NPO, or nothing by mouth, before a standard EEG. The client can eat and drink normally, unless the provider instructs otherwise.

Choice B reason: This is an incorrect instruction, because the client should not take a sedative, or any other medication that can affect the brain activity, before a standard EEG. The client should take the usual medications, unless the provider instructs otherwise.

Choice C reason: This is the correct instruction, because the client should thoroughly shampoo hair prior to the EEG. The client should wash the hair with a mild shampoo and rinse well, without using any conditioner, gel, spray, or other hair products. This can help remove any oil, dirt, or residue that can interfere with the placement and function of the electrodes.

Choice D reason: This is an incorrect instruction, because the client should not take an additional dose of anticonvulsant medication before a standard EEG. The client should take the regular dose of anticonvulsant medication, unless the provider instructs otherwise.

A. Cholesterol level 195 mg/dL B. Elevated HDL levels C. Elevated LDL levels D. Triglyceride level 135 mg/dL

Correct Answer is C

Explanation

Choice A reason: A cholesterol level of 195 mg/dL is not an increased risk for atherosclerosis, because it is within the normal range of less than 200 mg/dL. Cholesterol is a type of fat that circulates in the blood and can contribute to plaque formation in the arteries.

Choice B reason: Elevated HDL levels are not an increased risk for atherosclerosis, because HDL stands for high-density lipoprotein, which is the "good" cholesterol that helps to remove excess cholesterol from the blood and prevent plaque formation in the arteries.

Choice C reason: Elevated LDL levels are an increased risk for atherosclerosis, because LDL stands for low-density lipoprotein, which is the "bad" cholesterol that can deposit in the arterial walls and cause plaque formation and narrowing of the arteries.

Choice D reason: A triglyceride level of 135 mg/dL is not an increased risk for atherosclerosis, because it is within the normal range of less than 150 mg/dL. Triglycerides are another type of fat that circulates in the blood and can contribute to plaque formation in the arteries.

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A nurse is assisting with the care of a client who has a chest tube in place following a thoracotomy. Which of the following actions should the nurse take?

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