A nurse working on the postoperative floor has four patients who are scheduled to be discharged tomorrow. Which patient has the greatest need for the nurse to consult with other members of the healthcare team regarding post-discharge care?
A young patient who lives alone, but has nearby family and friends.
An older adult who lives alone at home, despite some memory loss.
A married young adult who is the primary caregiver for children.
A middle-aged patient who has undergone knee replacement and requires physical therapy.
The Correct Answer is B
Choice A rationale:
While a young patient who lives alone may need some assistance with post-discharge care, they have nearby family and friends who can likely provide this support. This patient's situation does not present the same level of complexity and risk as the other patients described in the options.
The presence of nearby family and friends can offer practical and emotional support, helping with tasks such as transportation, meal preparation, and medication management. This social support network can play a crucial role in ensuring a smooth transition from the hospital to home.
Additionally, the patient's young age suggests a higher likelihood of physical and cognitive abilities that can facilitate self-care and adherence to discharge instructions.
Choice B rationale:
The older adult who lives alone and has memory loss has the greatest need for the nurse to consult with other members of the healthcare team regarding post-discharge care. This patient's situation presents several significant challenges that necessitate a collaborative approach to ensure safety and well-being:
Memory loss: The patient's memory loss may impair their ability to follow discharge instructions, manage medications, and maintain personal safety. This raises concerns about potential medication errors, missed appointments, and risks of falls or accidents.
Living alone: The patient's lack of immediate support at home further compounds these risks. Without someone to provide reminders, assistance with tasks, or monitoring for changes in health status, the patient's vulnerability increases.
Potential for social isolation: Living alone with memory loss can also lead to social isolation, which can negatively impact mental and physical health.
Choice C rationale:
While a married young adult who is the primary caregiver for children may face challenges in balancing their own recovery with caregiving responsibilities, they have a spouse who can provide support and assistance. This patient's situation does not present the same degree of risk as the older adult with memory loss living alone.
Choice D rationale:
The middle-aged patient who has undergone knee replacement and requires physical therapy will need support and guidance, but their needs are primarily focused on physical rehabilitation and pain management. These needs can often be addressed through standard discharge planning and coordination with physical therapy services.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","D","E"]
Explanation
Choice A rationale:
Prednisone:
Corticosteroid that suppresses the immune system: It's crucial to consult with the primary healthcare provider (PCP) because prednisone can impair wound healing and increase the risk of infection after surgery. The PCP may need to adjust the dosage or temporarily discontinue prednisone prior to surgery.
Potential for adrenal insufficiency: Abrupt cessation of prednisone can lead to adrenal insufficiency, a life-threatening condition. The PCP will provide guidance on how to taper the medication safely before surgery.
Interaction with anesthesia: Prednisone can interact with certain anesthetic agents, potentially increasing the risk of complications. The PCP and anesthesiologist will need to coordinate care to ensure safe medication management during surgery.
Choice B rationale:
Metoprolol:
Beta-blocker that lowers blood pressure and heart rate: While metoprolol is generally safe to continue before surgery, it's still essential to inform the PCP and anesthesiologist about its use. They will monitor heart rate and blood pressure closely during and after surgery, as metoprolol can interact with certain medications used during the procedure.
Choice C rationale:
Warfarin:
Blood thinner that prevents blood clots: Warfarin requires careful management around surgery due to its significant bleeding risk. The PCP will typically recommend holding warfarin for several days before surgery to allow for normalization of blood clotting. They may also bridge with a shorter-acting anticoagulant if necessary.
Potential for bleeding complications: If warfarin is not managed appropriately, it can lead to excessive bleeding during or after surgery. The PCP will closely monitor the patient's INR (international normalized ratio), a measure of blood clotting, to ensure it's within the safe range for surgery.
Choice D rationale:
Insulin:
Hormone that regulates blood sugar: Patients with diabetes who take insulin require careful blood sugar control around surgery to prevent complications. The PCP will provide specific instructions on how to adjust insulin doses before, during, and after surgery, as insulin needs often change due to the stress of surgery and the impact of anesthesia.
Risk of hypoglycemia and hyperglycemia: Both low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia) can have serious consequences during and after surgery. The PCP will work with the patient to manage blood sugar levels and prevent these complications.
Choice E rationale:
Phenytoin:
Anticonvulsant medication that controls seizures: Phenytoin has a narrow therapeutic window, meaning that blood levels must be closely monitored to ensure efficacy and prevent toxicity. Surgery can affect phenytoin levels, so the PCP will likely recommend checking a blood level before surgery and adjusting the dose as needed.
Potential for drug interactions: Phenytoin interacts with many medications, including some commonly used during surgery. The PCP will need to review the patient's medication list carefully and make any necessary adjustments to prevent interactions.
Choice F rationale:
Omega-3 fatty acid:
Generally safe to continue before surgery: Omega-3 fatty acids are not known to have significant interactions with medications used during surgery or to pose risks for wound healing or bleeding. However, it's always best to inform the PCP about any supplements being taken.
Correct Answer is B
Explanation
Choice A rationale:
While advancing age is a significant risk factor for cancer, it is not considered the single biggest risk factor. The risk of developing cancer does increase with age, primarily due to the accumulation of DNA damage over time. This damage can arise from various sources, including exposure to carcinogens, errors in DNA replication, and oxidative stress. With age, the body's ability to repair DNA damage also declines, making cells more susceptible to cancerous changes.
However, it's important to note that cancer can develop at any age, and even younger individuals can be affected if exposed to other significant risk factors.
Choice B rationale:
Exposure to tobacco is widely recognized as the single biggest risk factor for developing cancer. It is estimated to be responsible for about 25-30% of all cancer deaths worldwide.
Tobacco smoke contains over 70 known carcinogens, which are substances that can damage DNA and lead to cancer. These carcinogens can affect various organs in the body, including the lungs, mouth, throat, esophagus, stomach, pancreas, liver, bladder, kidney, cervix, and colon.
The risk of cancer increases with the amount and duration of tobacco use. Even exposure to secondhand smoke can increase the risk of cancer.
Quitting tobacco use is the most effective way to reduce the risk of cancer.
Choice C rationale:
Exposure to occupational chemicals is a known risk factor for certain types of cancer, such as lung cancer, bladder cancer, and leukemia. However, it is not considered the single biggest risk factor for developing cancer overall.
The risk of cancer from occupational chemicals depends on the specific chemical, the level of exposure, and the duration of exposure.
Workplace safety measures, such as using protective equipment and limiting exposure to hazardous chemicals, can help reduce the risk of cancer.
Choice D rationale:
Infection with certain viruses, known as oncoviruses, can increase the risk of developing certain types of cancer. For example, infection with human papillomavirus (HPV) can increase the risk of cervical cancer, and infection with hepatitis B virus (HBV) can increase the risk of liver cancer.
However, oncoviruses are not considered the single biggest risk factor for developing cancer overall. Vaccines are available to protect against some oncoviruses, such as HPV and HBV.
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