The nurse is caring for a client after a total thyroidectomy. The nurse's priority should be to:

Encourage the client to cough and deep breathe every two hours, with her neck in a flexed position.

Maintain the client in a Fowler's position, with head neutral supported by pillows.

Maintain the client in a supine position, with sandbags placed on either side of her head and neck.

Encourage the client to turn head side to side, to promote drainage of oral secretions.

Answer and Explanation

The Correct Answer is B

Choice A Reason: Encouraging the client to cough and deep breathe every two hours, with her neck in a flexed position, is not a priority for a client after a total thyroidectomy, as it may increase the risk of bleeding or damage to the surgical site.

Choice B Reason: Maintaining the client in a Fowler's position, with head neutral supported by pillows, is a priority for a client after a total thyroidectomy, as it helps to reduce swelling and edema, prevent airway obstruction, and promote venous drainage.

Choice C Reason: Maintaining the client in a supine position, with sandbags placed on either side of her head and neck, is not a priority for a client after a total thyroidectomy, as it may impair breathing and circulation, increase pressure on the surgical site, and cause neck stiffness.

Choice D Reason: Encouraging the client to turn head side to side, to promote drainage of oral secretions, is not a priority for a client after a total thyroidectomy, as it may cause pain and discomfort, disrupt the sutures or drains, and increase the risk of infection.

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Correct Answer is A

Explanation

Choice A Reason: Checking blood sugar then eating breakfast prior to injecting insulin indicates that additional teaching is necessary, as it may cause hyperglycemia or hypoglycemia depending on the type and timing of insulin. The client should inject insulin before eating breakfast according to their blood sugar level and carbohydrate intake.

Choice B Reason: Rotating sites from arms, legs, and abdomen indicates that no additional teaching is necessary, as it helps to prevent lipodystrophy and ensure consistent absorption of insulin.

Choice C Reason: Ensuring the use of insulin syringe with units indicates that no additional teaching is necessary, as it helps to prevent dosing errors and ensure accurate administration of insulin.

Choice D Reason: Activating the safety lock on the syringe before disposing in a sharps container indicates that no additional teaching is necessary, as it helps to prevent needlestick injuries and infection transmission.

A. Instruct the client to restrict food intake prior to treatment. B. Encourage the client to drink a carbonated beverage 1 hr before meals. C. Provide the client with an antiemetic 2 hours prior to the chemotherapy. D. Advise the client to lie down after meals.

Correct Answer is C

Explanation

The correct answer is: C. Provide the client with an antiemetic 2 hours prior to the chemotherapy.

Choice A reason:

Instructing the client to restrict food intake prior to treatment is not the best approach. While it might reduce nausea temporarily, it can lead to weakness and nutritional deficiencies. Chemotherapy patients need adequate nutrition to maintain their strength and immune function.

Choice B reason:

Encouraging the client to drink a carbonated beverage 1 hour before meals can sometimes help with mild nausea, but it is not as effective as antiemetic medications. Carbonated beverages may provide temporary relief but do not address the underlying cause of chemotherapy-induced nausea.

Choice C reason:

Providing the client with an antiemetic 2 hours prior to chemotherapy is the most effective action. Antiemetics are specifically designed to prevent nausea and vomiting associated with chemotherapy. Administering them before treatment helps to manage symptoms proactively, improving the client's comfort and ability to tolerate chemotherapy.

Choice D reason:

Advising the client to lie down after meals is not recommended as it can worsen nausea and increase the risk of gastroesophageal reflux. It is generally better for clients to remain upright for a period after eating to aid digestion and reduce nausea.

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The nurse is caring for a client after a total thyroidectomy. The nurse's priority should be to:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

When evaluating a client how to administer insulin, which action indicates that additional teaching is necessary?

Correct Answer is A

Explanation

A nurse is caring for a client who is receiving chemotherapy for treatment of ovarian cancer and experiencing nausea. Which of the following actions should the nurse take?

Correct Answer is C

Explanation

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