A nurse is assisting with the plan of care for a client who is 4 hr postoperative from a subtotal thyroidectomy. Which of the following implementations should the nurse recommend?

Check for bleeding on the dressing at the back of the client’s neck.

Ensure that acetylcysteine IV is readily available.

Place the client in a side-lying position.

Check the client for asterixis.

Answer and Explanation

The Correct Answer is A

Choice A: Check for bleeding on the dressing at the back of the client’s neck. This is an implementation that the nurse should recommend for a client who is 4 hr postoperative from a subtotal thyroidectomy, which is a surgical removal of part of the thyroid gland. The nurse should check for bleeding on the dressing at the back of the client’s neck because this is where blood can pool and go unnoticed. Bleeding can cause hematoma, compression of the airway, and respiratory distress.

Choice B: Ensure that acetylcysteine IV is readily available. This is not an implementation that the nurse should recommend for a client who is 4 hr postoperative from a subtotal thyroidectomy. Acetylcysteine IV is an antidote for acetaminophen overdose, which can cause liver damage, but it is not related to thyroid surgery.

Choice C: Place the client in a side-lying position. This is not an implementation that the nurse should recommend for a client who is 4 hr postoperative from a subtotal thyroidectomy. The nurse should place the client in a semi-Fowler’s position, which is a position with the head of the bed elevated to 30 to 45 degrees. This position can facilitate breathing, reduce edema, and prevent aspiration.

Choice D: Check the client for asterixis. This is not an implementation that the nurse should recommend for a client who is 4 hr postoperative from a subtotal thyroidectomy. Asterixis is a sign of hepatic encephalopathy, which is a condition caused by liver failure, but it is not related to thyroid surgery.

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Correct Answer is A

Explanation

Choice A: Determine the client’s calcium level. This is the priority action for the nurse to take because the client might have hypocalcemia, which is a low level of calcium in the blood. Hypocalcemia can occur after a thyroidectomy due to accidental removal or damage of the parathyroid glands, which regulate calcium levels. Hypocalcemia can cause muscle spasms, tetany, paresthesia, and seizures.

Choice B: Give the client an oral potassium supplement. This is not an appropriate action for the nurse to take because the client might have hyperkalemia, which is a high level of potassium in the blood. Hyperkalemia can also occur after a thyroidectomy due to damage to the adrenal glands, which regulate potassium levels. Hyperkalemia can cause muscle weakness, arrhythmias, and cardiac arrest.

Choice C: Administer intravenous normal saline solution. This is not a necessary action for the nurse to take because the client does not have signs of dehydration or ﬂuid imbalance. Normal saline solution does not aﬀect calcium or potassium levels.

Choice D: Monitor the client’s peripheral pulses. This is an important action for the nurse to take, but not the priority. The nurse should monitor the client’s peripheral pulses for signs of decreased perfusion or ischemia, which can result from hypocalcemia or hyperkalemia aﬀecting the cardiac function. However, this should be done after determining the client’s calcium level and correcting it if needed.

A. “Monitor blood glucose levels every 4 hours.” B. “Consume 15 grams of carbohydrates every 1 to 2 hours.” C. “Drink 8 ounces of ﬂuid every hour while awake.” D. “Take the usual dosage of insulin.”

Correct Answer is A

Explanation

Choice A: “Monitor blood glucose levels every 4 hours.” This is the priority action for the nurse to recommend to the client because it will help them detect and prevent hyperglycemia or hypoglycemia, which can lead to serious complications such as diabetic ketoacidosis or cerebral edema.

Choice B: “Consume 15 grams of carbohydrates every 1 to 2 hours.” This is an important action for the nurse to recommend to the client, but not the priority. The client should consume carbohydrates to prevent hypoglycemia, especially if they have nausea, vomiting, or diarrhea, but this should be done after monitoring their blood glucose levels.

Choice C: “Drink 8 ounces of ﬂuid every hour while awake.” This is a necessary action for the nurse to recommend to the client, but not the priority. The client should drink ﬂuids to prevent dehydration and electrolyte imbalance, which can worsen hyperglycemia, but this should be done after monitoring their blood glucose levels.

Choice D: “Take the usual dosage of insulin.” This is a required action for the nurse to recommend to the client, but not the priority. The client should take their insulin as prescribed to control their blood glucose levels, but this should be done after monitoring their blood glucose levels and adjusting the dosage if needed.

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