A nurse is caring for a client who has a newly implanted sealed internal radiation device to treat cervical cancer. Which of the following is an appropriate action for the nurse to take?
Prohibit visitors for the first 24 hr.
Keep a 3-foot distance from the radiation implant.
Maintain the client on bed rest for 72 hr.
Require the client wear a dosimeter badge.
The Correct Answer is B
A. Visitors are not completely prohibited, but their time should be limited and precautions followed, especially for children and pregnant individuals. Therefore, banning all visitors for 24 hours is unnecessary and overly restrictive.
B. Maintaining a distance of at least 3 feet from the radiation source helps reduce exposure, following the principle of distance in radiation safety. This is an appropriate and effective protective measure for the nurse.
C. Bed rest is typically required to prevent displacement of the sealed radiation device, but it is not specifically prescribed for a fixed duration like 72 hours. The duration depends on the treatment plan, so this statement is too rigid and not universally correct.
D. Dosimeter badges are worn by healthcare workers to measure occupational exposure, not by clients receiving radiation therapy. Therefore, this action is inappropriate for the client.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. A gastric residual volume of 250 mL following 2 hours of infusion may indicate potential intolerance to the feeding, but it is not necessarily an immediate emergency unless it exceeds the facility’s threshold for residuals.
B. The client lying in a supine position poses a significant risk for aspiration, especially following a laryngectomy, where airway protection is compromised. Immediate intervention is necessary to reposition the client and reduce the risk of aspiration pneumonia.
C. While the infusion pump being off is concerning, it may not require immediate intervention as long as the nurse is aware and can address it promptly.
D. Not dating the enteral feeding bag and tubing is important for infection control; however, it does not require immediate intervention compared to the risk posed by a supine position.
Correct Answer is A
Explanation
A.
A. A BMI of 20 falls within the healthy weight range for adults, indicating that the client's weight is appropriate for his height.
B. A BMI of 20 is not indicative of malnutrition. Malnutrition is typically associated with lower BMIs.
C. A BMI of 20 is not within the overweight range, as overweight is typically defined as a BMI between 25 and 29.9.
D. A BMI of 20 is not within the obesity range, as obesity is typically defined as a BMI of 30 or higher.
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