Which nursing action should be included in the plan of care for a patient returning to the surgical unit after a left modified radical mastectomy with dissection of axillary lymph nodes?
Post a sign at the bedside warning against venipunctures or blood pressures in the left arm.
Obtain a permanent breast prosthesis before the patient is discharged from the hospital.
Teach the patient to use the ordered patient-controlled analgesia every 10 minutes.
Insist that the patient examine the surgical incision when the initial dressings are removed.
The Correct Answer is A
Choice A rationale: Post-surgery, there's a risk of lymphedema in the affected arm, so avoiding procedures like venipuncture or blood pressure measurements in the left arm helps prevent complications.
Choice B rationale: Obtaining a permanent breast prosthesis is a consideration post- recovery but not an immediate priority upon return to the surgical unit.
Choice C rationale: Patient-controlled analgesia instructions are important but don't specifically address immediate care after mastectomy.
Choice D rationale: Insisting that the patient examine the surgical incision might not be appropriate upon return to the unit, and it's typically done by healthcare professionals during dressing changes.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale: Biopsy during an endoscopy can help confirm the presence of duodenal ulcers by analyzing tissue samples.
Choice B rationale: Urea breath test is used to detect the presence of Helicobacter pylori, a bacterium associated with duodenal ulcers.
Choice C rationale: Endoscopy is a standard procedure for diagnosing duodenal ulcers by directly visualizing the upper gastrointestinal tract.
Choice D rationale: While a CT scan can be useful in some cases, it's less commonly used for diagnosing duodenal ulcers compared to other diagnostic methods like endoscopy,
biopsy, or urea breath test.
Correct Answer is A
Explanation
Choice A rationale: The correct answer is 5 units/hour. To calculate the units of insulin per hour, we need to use the following formula: units of insulin per hour = (units of insulin in the bag / volume of the bag) x infusion rate
Plugging in the given values, we get:
units of insulin per hour = (50 / 100) x 10 units of insulin per hour = 0.5 x 10
units of insulin per hour = 5
Therefore, the client is receiving 5 units of insulin every hour.
Choice B rationale: This is incorrect because it assumes that the infusion rate is equal to the units of insulin per hour, which is not true.
Choice C rationale: This is incorrect because it multiplies the units of insulin in the bag by the infusion rate, which is too high.
Choice D rationale: This is incorrect because it adds the units of insulin in the bag and the infusion rate, which is also too high.
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