A nurse is caring for a client following a bronchoscopy. Which of the following actions should the nurse take first?

Check the client's gag reflex.

Inform the client they might experience a low-grade fever.

Provide the client with sips of water.

Instruct the client to report bleeding.

Answer and Explanation

The Correct Answer is A

The nurse should assess the client's gag reflex before allowing oral intake to prevent aspiration. The client's throat may be numb after a bronchoscopy, which is a procedure that uses a thin tube with a camera and light to examine the lungs and airways . The other actions are important but not the priority.

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Correct Answer is D

Explanation

Thrombocytopenia is a condition where the blood has a low platelet count, which can impair blood clotting and increase the risk of bleeding. Heparin is an anticoagulant that prevents blood clots from forming or growing, but it can also cause or worsen thrombocytopenia and bleeding.

Therefore, heparin is contraindicated for clients who have thrombocytopenia or are at risk of developing it. The other conditions are not contraindications to receiving heparin.

A. Measure the client's blood pressure. B. Prepare the client for temporary pacing. C. Initiate IV fluid therapy for the client. D. Administer atropine to the client.

Correct Answer is A

Explanation

The nurse should measure the client's blood pressure first, as sinus bradycardia can cause hypotension and decreased perfusion to vital organs. The nurse should assess the client's hemodynamic status and symptoms before initiating any interventions that may affect their heart rate or rhythm. The other options may be appropriate depending on the severity of the bradycardia and its underlying cause, but they are not the first priority.

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A nurse is caring for a client following a bronchoscopy. Which of the following actions should the nurse take first?

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Naxlex Comprehensive Predictor Exams

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