What is the most crucial nursing intervention to include in the care plan for a patient who is 12 hours post- thyroidectomy?
Anticipate and monitor for hypothermia.
Prepare to administer radioactive iodine treatments.
Resume antithyroid drug therapy.
Maintain a semi-Fowler position.
The Correct Answer is A
Choice A rationale
Anticipating and monitoring for hypothermia is the most crucial nursing intervention to include in the care plan for a patient who is 12 hours post-thyroidectomy. The thyroid gland plays a significant role in regulating the body’s metabolism, including temperature regulation. After a thyroidectomy, the body may struggle to regulate temperature, leading to hypothermia. The nurse should monitor the patient’s temperature regularly and provide warming measures as needed.
Choice B rationale
Preparing to administer radioactive iodine treatments is not the most crucial intervention at this time. Radioactive iodine is typically used as a treatment for hyperthyroidism or thyroid cancer, not as an immediate post-operative intervention.
Choice C rationale
Resuming antithyroid drug therapy is not the most crucial intervention at this time. Antithyroid drugs are used to treat hyperthyroidism, and their use would need to be evaluated based on the reason for the thyroidectomy and the patient’s post-operative thyroid hormone levels.
Choice D rationale
Maintaining a semi-Fowler position can be beneficial for comfort and respiratory function post-operatively, but it is not the most crucial intervention. The nurse should assist the patient to a comfortable position and encourage regular deep breathing and coughing exercises to prevent respiratory complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["60"]
Explanation
Step 1: We know that the medication is labeled as “750 mcg/2.4 mL”. This means that every 2.4 mL of the medication contains 750 mcg of teriparatide.
Step 2: We need to find out how many mL of the medication contains 60 mcg of teriparatide. We can set up a proportion to solve this: 750 mcg : 2.4 mL = 60 mcg : x mL Step 3: Solving for x gives us: x = (60 mcg * 2.4 mL) ÷ 750 mcg Step 4: Calculating the above expression gives us: x =
0.192 mL So, the nurse should administer 0.192 mL of the medication to deliver a dose of 60 mcg of teriparatide.
Correct Answer is A
Explanation
Choice A rationale
Testing the fluid on the dressing for glucose is the immediate course of action when a nurse notices clear fluid on the surgical dressing of a patient who has just returned from lumbar spinal surgery. Clear fluid could be cerebrospinal fluid (CSF), which contains glucose. If the fluid is positive for glucose, it could indicate a CSF leak, which requires immediate medical attention.
Choice B rationale
Changing the dressing using a compression bandage is not the immediate course of action. The source of the fluid needs to be identified first.
Choice C rationale
Marking the drainage area with a pen and continuing to monitor is not the immediate course of action. The source of the fluid needs to be identified first.
Choice D rationale
Documenting the findings in the electronic medical record is important, but it is not the immediate course of action. The source of the fluid needs to be identified first.
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