Which intervention is most important for the nurse to include in the plan of care for a client who is 12 hours post-thyroidectomy?

Resume antithyroid drug therapy.

Anticipate and monitor for hypothermia.

Prepare to administer radioactive iodine treatments.

Maintain a semi-Fowler position.

Answer and Explanation

The Correct Answer is D

A. Resume antithyroid drug therapy.
Antithyroid medications are typically not resumed immediately post-thyroidectomy unless specifically directed by the healthcare provider. The focus post-surgery is often on managing potential complications and ensuring proper healing.

B. Anticipate and monitor for hypothermia.
Hypothermia is not a common concern following thyroidectomy. The nurse should monitor for other more relevant complications such as bleeding, airway obstruction, and hypocalcemia.

C. Prepare to administer radioactive iodine treatments.
Radioactive iodine treatment is usually not administered immediately post-thyroidectomy. It may be considered later, depending on the reason for the thyroidectomy and the individual treatment plan.

D. Maintain a semi-Fowler position.
This is the correct intervention. Maintaining the client in a semi-Fowler position helps reduce strain on the surgical site, facilitates breathing, and minimizes the risk of complications such as bleeding and edema in the neck area. It is an essential part of postoperative care for
thyroidectomy patients.

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Correct Answer is []

Explanation

- Potential Condition:

Stage 2 pressure injury

- Actions to Take:

C. Clean the area and dry carefully: Proper wound care involves cleaning the area to prevent infection and promote healing. Cleaning the erythematous area on the left heel and ensuring
it is dry can help prevent further skin breakdown and promote healing.

B. Hold the hydrochlorothiazide: Hydrochlorothiazide is a diuretic that can increase urine output and potentially lead to dehydration, which may exacerbate the client's condition. Holding the medication temporarily can help prevent further fluid loss and dehydration, which is crucial for wound healing.

- Parameters to Monitor:

B. Skin color: Monitoring the skin color around the erythematous area on the left heel can help assess tissue perfusion and identify any signs of deterioration or improvement in the wound condition.
D. Fluid balance: Monitoring the client's fluid balance, including intake and output, is essential for assessing hydration status and ensuring adequate tissue perfusion, which is vital for wound healing and overall patient well-being.

A. Provide counseling that most contraceptives protect against infection. B. Remain non-judgmental and assure the client of confidentiality. C. Inform the client that complications will not result from reinfection. D. Clarify that all STIs are transmitted through sexual intercourse.

Correct Answer is B

Explanation

A. Providing counseling about contraceptives may not address the immediate concern of managing genital herpes or the risks associated with multiple sexual partners.
B. Remaining non-judgmental and assuring the client of confidentiality is crucial to establishing trust and ensuring open communication. This approach encourages the client to share accurate information about their sexual history and current concerns, which is essential for effective STI management and prevention.
C. Informing the client that complications will not result from reinfection is inaccurate and may minimize the seriousness of the STI. Genital herpes can cause recurrent outbreaks and potentially lead to complications such as neonatal herpes if transmitted to a newborn during childbirth.

D. Clarifying that all STIs are transmitted through sexual intercourse is true but does not address the client's specific situation or provide guidance on managing genital herpes and reducing the risk of transmission.

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Which intervention is most important for the nurse to include in the plan of care for a client who is 12 hours post-thyroidectomy?

Nursing Test Bank

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Correct Answer is []

Explanation

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Correct Answer is B

Explanation

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