The nurse recognizes the need for client education when the client scheduled for a computed tomography (CT) states:
"I will be drinking a lot of fluid after the test is over."
"I will be anesthetized so that I lie perfectly still during the procedure."
"I will make sure I let them know I do not have a shellfish ally."
"will follow the food and drink restrictions as directed before the test is scheduled."
The Correct Answer is B
A. This statement suggests that the client may not understand the purpose or procedure of the CT scan. CT scans typically do not require the client to drink excessive fluids afterward. However, hydration might be encouraged if contrast dye was used to help eliminate it from the body. Education is needed to clarify post-procedure instructions.
B. This statement indicates a misconception about the procedure. CT scans do not usually require anesthesia unless it's a complex situation, such as a young child or someone with severe claustrophobia. It's essential to educate the client about what to expect during the CT scan to reduce anxiety and ensure cooperation during the procedure.
C. This statement shows awareness of potential allergies to contrast dye, which often contains iodine. It indicates that the client understands the importance of disclosing allergies to the healthcare team before the procedure. While this is generally a positive sign of awareness, further education may still be needed to ensure complete understanding of allergy management.
D. This statement demonstrates understanding of pre-procedure instructions, which often include fasting or specific dietary restrictions. It suggests that the client understands the importance of these restrictions to ensure accurate test results and safety during the CT scan.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Heparin should be administered using IV tubing that is specifically labeled for heparin or that has been dedicated for anticoagulant use only. However, this is not the most important action.
B. Heparin is not typically administered as a bolus (large single dose) because of its rapid onset of action and potential for causing bleeding complications. Instead, heparin is usually administered as a continuous IV infusion to achieve and maintain therapeutic anticoagulation.
C. While vitamin K is an antidote for reversing the effects of warfarin (a different type of anticoagulant), it is not used for reversing the effects of heparin. The reversal agent for heparin is protamine sulfate. Therefore, having vitamin K available is not necessary for managing a client receiving heparin.
D. The aPTT is a laboratory test used to monitor the therapeutic effect of heparin therapy. It measures the clotting time of blood and helps ensure that the client's heparin infusion is within the desired therapeutic range. Checking aPTT regularly (usually every 4-6 hours initially, then adjusting based on results) is essential to maintain therapeutic anticoagulation and avoid complications like bleeding or clotting.
Correct Answer is ["A","B","C","E"]
Explanation
A. Postoperative patients often experience muscle tension and discomfort due to lying in one position for an extended period. A gentle back massage can help relieve muscle stiffness, promote relaxation, and improve circulation. It is a non-invasive comfort measure that can enhance the client's overall well- being.
B. Teaching relaxation techniques such as deep breathing exercises, guided imagery, or progressive muscle relaxation can help the client manage pain, reduce anxiety, and promote faster recovery. These techniques are beneficial postoperatively as they encourage relaxation and improve overall comfort.
C. Postoperative clients are at risk of developing respiratory complications such as atelectasis (partial lung collapse) or pneumonia due to shallow breathing or inadequate lung expansion. Coughing and deep breathing exercises help to clear secretions, improve lung function, and prevent respiratory complications. It is typically recommended to perform these exercises every hour to maintain lung expansion and prevent complications.
D. Encouraging the client to turn every 2 hours (D), not every 4 hours, is essential to prevent pressure ulcers and promote circulation.
E. Postoperative pain management is essential for the client's comfort and recovery. Pain can interfere with the client's ability to cough, deep breathe, and move effectively, which may increase the risk of complications. Administering analgesics as needed helps to control pain, improve overall comfort, and promote participation in necessary activities such as coughing, deep breathing, and turning.
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