A nurse is caring for a patient on a Medical-Surgical unit with a wound that has a drain and a dressing that needs changing. Which action should the nurse take first?

Provide wound irrigation.

Avoid accidentally removing the drain.

Gather supplies.

Provide analgesic medication as ordered by Provider.

Answer and Explanation

The Correct Answer is C

Choice A rationale:

Providing wound irrigation might be necessary during the dressing change, but it is not the first action the nurse should take. First, the nurse should ensure they have all the necessary supplies to prevent interruptions during the procedure.

Choice B rationale:

While avoiding accidentally removing the drain is important, it is not the first action the nurse should take. Ensuring that all supplies are gathered and ready will help facilitate a smooth and organized dressing change.

Choice C rationale:

Gathering supplies is the priority in this situation. Having all the needed supplies readily available ensures that the dressing change can be carried out efficiently and without unnecessary delays.

Choice D rationale:

Providing analgesic medication as ordered by the provider is important for the patient's comfort during the procedure. However, it should not be the first action the nurse takes. First, the nurse should ensure that they have all the necessary supplies to conduct the dressing change safely.

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Correct Answer is D

Explanation

Choice A rationale:

Intramuscular administration involves injecting medication into muscle tissue, which may result in slower and variable absorption rates. It is not the optimal route for providing fast and complete absorption of Furosemide.

Choice B rationale:

Subcutaneous administration delivers medication into the fatty tissue beneath the skin. While it can be used for some medications, it generally results in slower absorption compared to intravenous administration, and it may not be suitable for Furosemide, which requires rapid action in a severe heart failure situation.

Choice C rationale:

Oral administration involves taking medication by mouth, and the absorption process can be influenced by factors such as gastric emptying and gastrointestinal transit time. In an urgent scenario of severe heart failure, oral administration might be too slow and unpredictable.

Choice D rationale:

Intravenous administration allows for the fastest and most complete absorption of Furosemide. By directly delivering the medication into the bloodstream, it bypasses the absorption barriers of the gastrointestinal tract, leading to rapid onset of action and predictable effects, which is crucial in managing acute heart failure. This route is commonly used in critical situations where immediate therapeutic effects are needed.

A. Pigeon. B. Funnel. C. Kyphotic. D. Barrel.

Correct Answer is D

Explanation

Choice A rationale:

The choice "Pigeon" is not the correct answer. Pigeon chest, also known as pectus carinatum, is a deformity of the chest characterized by a protrusion of the sternum and ribs. This condition is not associated with chronic bronchitis.

Choice B rationale:

The choice "Funnel" is not the correct answer. Funnel chest, or pectus excavatum, is a deformity where the sternum is sunken into the chest. It is not the expected chest shape in chronic bronchitis.

Choice C rationale:

The choice "Kyphotic" is not the correct answer. Kyphosis refers to an excessive outward curvature of the thoracic spine, leading to a rounded upper back appearance. This is not the typical chest shape seen in chronic bronchitis.

Choice D rationale:

The correct answer is "Barrel." Choice D is the correct answer. Chronic bronchitis is a type of chronic obstructive pulmonary disease (COPD) characterized by airway inflammation and narrowing. Over time, this can lead to air trapping in the lungs and an increase in the anteroposterior diameter of the chest. This results in a barrel-shaped chest appearance, where the chest appears rounded and the ribs are more horizontal. This adaptation allows for increased lung capacity to accommodate for the compromised airflow in patients with chronic bronchitis.

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A nurse is caring for a patient on a Medical-Surgical unit with a wound that has a drain and a dressing that needs changing. Which action should the nurse take first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A Medical-Surgical nurse is preparing to administer Furosemide to a patient who is having severe heart failure. Which route of administration should the nurse use to provide the fastest and most complete absorption of Furosemide?

Correct Answer is D

Explanation

A nurse is assessing a patient who has chronic bronchitis. The nurse should expect the patient's chest to be which of the following shapes?

Correct Answer is D

Explanation

A nurse on a Medical-Surgical unit is caring for a client who has a suspected malignant lesion. Which of the following findings should the nurse expect when assessing the lesion? (Select all that apply.).

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A nurse is providing teaching to a client about preventing skin cancer. Which of the following client statements indicates a need for further teaching?

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A nurse is teaching a client's spouse about how to obtain a blood pressure reading. Which of the following actions by the spouse indicates a need for further instruction?

A nurse is developing a plan of care for a client who has COPD. The nurse should include which of the following interventions in the plan?

A nurse on a Medical-Surgical unit is preparing to administer an intramuscular injection to a client. Which of the following sites can the nurse use? (Select all that apply.).

A nurse is caring for a client who has emphysema. Which of the following findings should the nurse expect to see in this client? (Select all that apply.).