The nurse is caring for a client who is going to have an intravenous pyelogram (IVP) using a contrast medium. Which of the following assessments by the nurse are of the highest priority?
Ask whether the patient has any questions about the procedure.
Ask the patient to void before the procedure.
Check for an allergy to iodine or shellfish.
Assess the client's ability to remain still for the procedure.
The Correct Answer is C
Choice A reason: While it is important to address any questions the patient may have, it is not the highest priority before an IVP procedure.
Choice B reason: Asking the patient to void before the procedure is a standard practice, but it is not the highest priority. The bladder should be empty to allow for clear imaging, but this can be managed at the time of the procedure.
Choice C reason: Checking for an allergy to iodine or shellfish is the highest priority because the contrast medium used in an IVP can cause severe allergic reactions in patients with these allergies. This assessment must be done before administering the contrast to prevent potentially life-threatening complications.
Choice D reason: Assessing the client's ability to remain still is important for the quality of the images, but it is not as critical as ensuring the safety of the patient regarding potential allergic reactions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason : Maintenance chemotherapy is not typically used to maintain remission in Hodgkin's lymphoma after successful treatment.
Choice B reason : Follow-up appointments are crucial for monitoring any signs of recurrence or secondary malignancies, as well as managing long-term effects of treatment.
Choice C reason : The potential impact of chemotherapy on fertility is an important topic, especially for younger patients, but may not be as relevant for a 55-year-old woman.
Choice D reason : Addressing symptoms like pruritus, which can persist after treatment, is important for patient comfort and quality of life.
Correct Answer is D
Explanation
Choice A reason: While having at least one stool per day is a sign that lactulose is working, it does not directly indicate its effectiveness in reducing ammonia levels and improving mental status.
Choice B reason: Denial of nausea and vomiting is positive but is not a direct indicator of lactulose's effectiveness in treating hepatic encephalopathy.
Choice C reason: A decrease in bilirubin levels may be a positive sign, but it is not a direct indicator of lactulose's effectiveness in treating hepatic encephalopathy.
Choice D reason: The client being alert and oriented is a direct indicator that lactulose is effectively reducing ammonia levels and improving mental status, which is a key goal in treating hepatic encephalopathy associated with liver cirrhosis.
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