A nurse is caring for a client who is postoperative following a complete thyroidectomy. Which of the following findings is the priority for the nurse to report to the provider?
Client report of nausea
Serosanguineous drainage
Muscle twitching
Client report of incisional pain
The Correct Answer is C
C. Muscle twitching post-thyroidectomy can indicate hypocalcemia, a common complication due to inadvertent damage or removal of the parathyroid glands during surgery. Hypocalcemia can lead to neuromuscular irritability, including muscle twitching, tingling, or tetany.
A Nausea is a common postoperative symptom and can be caused by anesthesia, pain medications, or changes in gastrointestinal function. While uncomfortable, nausea alone is typically not an urgent concern
B Serosanguineous drainage (thin, pink-tinged fluid) from the surgical incision is expected in the early postoperative period. It indicates normal wound healing and does not usually require urgent attention
D. Routine incisional pain does not typically require urgent reporting unless accompanied by other concerning symptoms.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
B. This statement encourages the client to actively participate in their dietary planning by involving them in the process of selecting foods they enjoy. It empowers the client to collaborate with the dietitian in creating a meal plan that suits their preferences
A While empathetic, it does not actively encourage the client's involvement in their care plan or decision-making process.
C. While this statement reassures the client about the expertise of the dietitian, it does not actively encourage the client's active participation or involvement in decision-making regarding their dietary choices.
D. This statement acknowledges the need for adjustments but does not specifically encourage the client's active involvement in planning their dietary choices.
Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"B"}
Explanation
The nurse should administer a total 1320ml sodium chloride in the first hour, 880ml each subsequent hour.
Rationale
First Hour Administration
Rate: 15 ml/kg/hr Client's weight: 88 kg
Calculation: 15 ml/kg/hr × 88 kg= 1320ml/hr
Therefore, in the first hour, the nurse should administer 1320 mL of 0.9% sodium chloride.
Subsequent Hour Administration
Rate: 10 ml/kg/hr Client's weight: 88 kg
Calculation: 10 ml/kg/hr × 88kg= 880mls
Therefore, each subsequent hour after the first, the nurse should administer 880 mL of 0.9% sodium chloride.
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