Mr. Jones is undergoing an open lung biopsy in the morning, and the nurse is educating the patient regarding the postoperative period. Which of the following statements should be included in the education?
"You will be discharged home immediately following the procedure."
"You will not need any supplemental oxygen."
"You most likely will have a chest tube inserted to allow your lung to re-expand."
"You will need to collect a sputum specimen."
The Correct Answer is C
A. Discharge immediately following an open lung biopsy is unlikely. The patient will need observation post-procedure for complications such as bleeding, infection, or pneumothorax, and it usually requires a stay in the hospital for monitoring.
B. It is unlikely that supplemental oxygen will not be needed following an open lung biopsy. The patient may require oxygen post-procedure due to potential respiratory compromise, such as atelectasis or pneumothorax.
C. A chest tube is commonly inserted after an open lung biopsy to allow the lung to re-expand and to drain air or fluid that may accumulate in the pleural space. This is a standard part of the postoperative care for this procedure.
D. Collecting a sputum specimen is not typically necessary immediately after an open lung biopsy. The focus will be on monitoring the patient’s respiratory status, ensuring proper lung expansion, and preventing complications like pneumothorax or bleeding.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","D","E"]
Explanation
A. Monitor for postural hypotension: This is unlikely in Cushing’s syndrome, where hypertension (not hypotension) is more common due to excess cortisol and fluid retention.
B. Assess blood glucose level: Hyperglycemia is common in Cushing’s syndrome due to the effects of cortisol on glucose metabolism, so monitoring blood glucose levels is essential.
C. Monitor for an irregular heart rate: While Cushing's syndrome can lead to electrolyte imbalances that may affect heart rhythm, this is not a primary intervention in Cushing's syndrome. Monitoring for hypertension and fluid retention is more critical.
D. Assess for neck vein distention: Elevated cortisol levels can lead to fluid retention and hypertension, contributing to neck vein distention, so this is an important observation.
E. Weigh the client daily: Fluid retention and weight gain are key features of Cushing's syndrome, so daily weight monitoring helps assess fluid status and detect rapid weight gain indicative of worsening symptoms.
Correct Answer is C
Explanation
A. Increase carbohydrate intake.: This is incorrect. Cushing’s disease is characterized by excessive cortisol, which can lead to increased blood glucose levels, making carbohydrate intake less desirable. Clients with Cushing's disease often need to manage their blood sugar levels, so they should not increase carbohydrates indiscriminately.
B. Limit intake of potassium-rich foods.: This is incorrect. In Cushing’s disease, elevated cortisol levels can lead to potassium depletion, so clients should actually increase their intake of potassium-rich foods to help counteract the effects of low potassium, not limit them.
C. Restrict sodium intake.: This is correct. Cushing’s disease often results in fluid retention and hypertension due to increased cortisol and aldosterone levels. Restricting sodium helps manage these symptoms and reduces the risk of complications such as edema and high blood pressure.
D. Decrease protein intake.: This is incorrect. While protein breakdown is a feature of Cushing's disease, protein intake should not necessarily be decreased. Adequate protein intake is important to prevent muscle wasting, a common issue in clients with Cushing’s disease.
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