A nurse is participating in interprofessional team meeting for a client. Which of the following information about the client should the nurse include?
The client’s vital signs are checked every 8 hr
The client has developed difficulty ambulating
The client has state-sponsored health insurance
The client's next dressing change is scheduled in 4 hr.
The Correct Answer is B
A) The client’s vital signs are checked every 8 hr: While vital signs are an important aspect of the client's health, this information is routine and doesn't provide new insights that would impact the overall plan of care during an interprofessional team meeting. It’s important to focus on changes in the client’s condition or specific concerns that require collaboration.
B) The client has developed difficulty ambulating: This is critical information to share during the interprofessional team meeting because it may require input from physical therapists, occupational therapists, or other specialists. Difficulty ambulating can indicate a need for reassessment of the client's mobility plan, and other team members need to be informed to develop appropriate interventions.
C) The client has state-sponsored health insurance: While the client’s insurance status is relevant for financial and discharge planning, it is not directly related to the clinical management or care coordination that would be discussed in an interprofessional team meeting. The focus should be on the client’s clinical condition and needs.
D) The client's next dressing change is scheduled in 4 hr: Although the dressing change is important for continuity of care, this is more of a task-related detail rather than critical clinical information that requires interprofessional discussion. The focus in a team meeting should be on the client's progress, challenges, and needs, not just routine care tasks.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A) "I should eat a high fat diet for several weeks": After a laparoscopic cholecystectomy, the client is typically advised to avoid high-fat foods for a period of time as the body adjusts to the absence of the gallbladder. High-fat foods can trigger discomfort, nausea, or diarrhea. Therefore, recommending a high-fat diet is not appropriate post-surgery.
B) "I should expect to have diarrhea until my diet changes": Diarrhea is a possible side effect following gallbladder removal, particularly due to the changes in bile flow. However, the client should not expect diarrhea indefinitely. Over time, the digestive system adjusts, and with dietary modifications, diarrhea often resolves. The client should not assume this will persist unless directed by the healthcare provider.
C) "I should expect to have nausea for several days": Nausea is not typically expected to last for several days following a laparoscopic cholecystectomy. While mild nausea can occur shortly after surgery, it should subside within a short time. If nausea persists beyond this period, the client should notify their healthcare provider for further evaluation.
D) "I should leave my steri-strips on until they fall off.": Steri-strips are used to help close the incision site and should remain in place until they naturally fall off, which usually occurs within 7–10 days after surgery. This statement indicates that the client understands the proper care for their incision site. It is important not to remove them prematurely to avoid disrupting the healing process.
Correct Answer is D
Explanation
A) Wear sterile gloves to remove the dressing: For a wet-to-dry dressing change, clean gloves are typically used when removing the dressing, as the procedure does not require a sterile technique unless the wound is being directly cleaned or treated with sterile instruments. Wearing sterile gloves for removal is unnecessary and could increase the risk of contamination when handling non-sterile dressing material.
B) Remove the tape by pulling from the center of the dressing: Tape should be removed by pulling it gently from the edges rather than from the center. Pulling from the center may cause unnecessary trauma to the surrounding skin or disrupt the wound's healing process. Gently pulling from the edges helps reduce the risk of skin irritation and minimizes discomfort for the patient.
C) Moisten dressing before removal: The dressing should be moistened before application, not before removal. Wetting the dressing before removing it may actually cause further trauma to the wound, and it might be difficult to remove the wet-to-dry dressing cleanly. The dressing should be removed first, and then a new dressing should be moistened if needed.
D) Clean the wound from the center to the outer edges: When cleaning a wound, the nurse should always clean from the center of the wound to the outer edges in a circular motion. This helps prevent the spread of bacteria from the outer contaminated areas into the clean tissue. By cleaning from the center outward, the nurse reduces the risk of introducing new bacteria into the wound site.
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