A nurse is caring for a client who has returned from the surgical suite following surgery for a fractured mandible. The client had intermaxillary fixation to repair and stabilize the fracture. Which of the following actions is the priority for the nurse to take?
Relieve the client's pain.
Promote oral hygiene
Ensure adequate nutrition
Prevent aspiration
The Correct Answer is D
A. Relieve the client's pain: While pain management is important for client comfort and recovery, it is not the priority immediately following intermaxillary fixation. Pain relief can be addressed once the more urgent concerns, such as preventing aspiration, are addressed.
B. Promote oral hygiene: Promoting oral hygiene is essential for preventing complications such as infection, but it is not the priority immediately after surgery and intermaxillary fixation. The client's airway and respiratory status should be the primary focus at this time.
C. Ensure adequate nutrition: Ensuring adequate nutrition is important for the client's overall recovery, but it is not the immediate priority after surgery and intermaxillary fixation. The priority is to prevent complications such as aspiration and maintain the client's airway.
D. Prevent aspiration: This is the priority action for the nurse. Intermaxillary fixation restricts the client's ability to open their mouth, increasing the risk of aspiration if vomiting occurs. The nurse should ensure that the client's airway is clear and that measures are in place to prevent aspiration, such as positioning the client appropriately and monitoring for signs of respiratory distress.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Requiring staff nurses to demonstrate competency by passing a medication administration examination: While competency assessments are essential, initiating this as the first strategy may not address the root causes of medication administration errors. It's important to first understand the specific factors contributing to errors by reviewing the events leading up to each error before implementing competency assessments. This allows for a targeted approach to addressing gaps in knowledge or skills related to medication administration.
B. Providing an in-service on medication administration to all nurses: While education and training are valuable components of error reduction strategies, providing an in-service as the first step may not address the underlying system issues contributing to medication errors. Education should complement other interventions aimed at improving the medication administration process, such as system redesign or standardization of practices.
C. Developing a quality improvement program for nurses involved in medication administration errors: Implementing a quality improvement program for nurses involved in errors is important for learning from mistakes and preventing recurrence. However, developing such a program should be informed by a thorough analysis of the events leading to errors. Without understanding the root causes, it may be challenging to develop effective improvement initiatives.
D. Reviewing the events leading up to each medication administration error: This strategy is the most appropriate initial step. Conducting a detailed review of each error allows the committee to identify patterns, common factors, and system issues contributing to medication errors. By understanding the specific circumstances surrounding each error, the committee can develop targeted interventions to address root causes and prevent future errors. This approach aligns with the principles of continuous quality improvement, focusing on data-driven analysis and proactive problem-solving.
Correct Answer is B
Explanation
A. Fresh frozen plasma: Fresh frozen plasma contains clotting factors, including factor VIII, but it is not the primary treatment for hemophilia A. While it can be used in emergency situations to temporarily increase clotting factor levels, it is not typically administered prophylactically before dental procedures.
B. Recombinant factor VIII: This is the correct answer. Recombinant factor VIII is the treatment of choice for individuals with hemophilia A. It is administered to replace the deficient factor VIII in the blood, thereby promoting clot formation and preventing excessive bleeding during surgical procedures such as wisdom teeth extractions.
C. Packed red blood cells (RBCs): Packed red blood cells are not typically indicated for the treatment of hemophilia A. While they may be necessary if significant blood loss occurs during the procedure, the primary treatment is replacement of the deficient clotting factor.
D. Prophylactic antibiotics: Prophylactic antibiotics may be prescribed to prevent infection following dental procedures, especially in individuals with bleeding disorders who are at increased risk of infection due to compromised immune function. However, the primary treatment for hemophilia A prior to dental procedures is replacement therapy with clotting factor concentrates like recombinant factor VIII.
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