A nurse is reviewing the medical history of a client who is scheduled for surgery.
Which of the following findings places the client at risk for an incisional hematoma?
The client has peripheral vascular disease.
The client has urinary incontinence.
The client takes anticoagulant medications.
The client is underweight.
The Correct Answer is C
Choice A rationale:
Peripheral vascular disease does not directly place the client at a higher risk for an incisional hematoma. While it is a vascular condition, the use of anticoagulant medications is a more significant risk factor for bleeding complications.
Choice B rationale:
Urinary incontinence is not directly related to an increased risk of incisional hematoma. Incontinence is a separate issue and does not influence surgical outcomes in the context of hematoma formation.
Choice C rationale:
Taking anticoagulant medications is a significant risk factor for incisional hematoma. Anticoagulants reduce the blood's ability to clot, which can lead to excessive bleeding at the surgical site and the formation of hematomas.
Choice D rationale:
Being underweight is not a primary risk factor for incisional hematoma. While poor nutrition and overall health can influence wound healing, anticoagulant use is a more direct concern for hematoma formation in surgical patients.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Tightening abdominal muscles is not the first action the nurse should take when repositioning a client. Repositioning a client requires proper body mechanics and coordination. Tightening abdominal muscles may not be as effective or safe as other actions in ensuring the client's safety during repositioning.
Choice B rationale:
Raising the height of the client's bed is not the first action the nurse should take when repositioning a client. Adjusting the bed height is a secondary consideration and can be done after ensuring proper body mechanics and patient safety during the repositioning process.
Choice C rationale:
Pivoting the feet in the direction of the move is a crucial step when repositioning a client. This action allows the nurse to maintain balance and control during the transfer. It also reduces the risk of injury to the nurse and the client. However, it is not the first action to be taken.
Choice D rationale:
Placing the feet in line with the shoulders is the first action the nurse should take when repositioning a client. This wide base of support provides stability and balance. It allows the nurse to maintain control during the repositioning process, reducing the risk of injury to both the nurse and the client. After achieving this stable stance, pivoting the feet in the direction of the move is the next step to facilitate the repositioning.
Correct Answer is B
Explanation
Choice A rationale:
Trust vs. Mistrust is the first stage of Erikson's theory of psychosocial development and typically occurs in infancy. It is characterized by the child's development of trust or mistrust based on the caregiver's reliability and care. This stage is not relevant to an adolescent who is rebelling against caregivers and spending more time with friends.
Choice B rationale:
Identity vs. Role Confusion is the stage of Erikson's theory that corresponds to adolescence. During this stage, adolescents seek to establish a sense of identity and may experiment with different roles and behaviors. They often question who they are and what they want to become. Rebelling against caregivers and seeking independence are common characteristics of this stage.
Choice C rationale:
Integrity vs. Despair is the final stage of Erikson's theory and occurs in late adulthood. It involves reflecting on one's life and coming to terms with the choices made. It is not relevant to the situation of an adolescent client.
Choice D rationale:
Autonomy vs. Shame and Doubt is the stage that typically occurs in early childhood, where children are developing a sense of independence and autonomy. This stage is not relevant to the adolescent client's experience of rebellion and seeking autonomy.
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