While assessing a patient who has just arrived in the post-anesthesia recovery unit (PACU) after a thyroidectomy, the nurse obtains this data. Which is the most important to communicate to the surgeon?

The patient’s voice is weak and hoarse sounding.

The patient is complaining of a 7/10 incisional pain.

The patient’s cardiac monitor shows a heart rate of 112.

The patient is increasingly swelling at the neck.

Answer and Explanation

The Correct Answer is D

This is a critical finding that could indicate bleeding or compromised airway, both of which are potentially life-threatening complications following a thyroidectomy. Immediate intervention may be necessary to prevent further harm to the patient. The other options are important to note and should be addressed, but they do not require immediate intervention as the swelling in the neck does.

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Correct Answer is A

Explanation

The plan of care for a patient with hypothermia and ﬂuid volume excess would typically include measures to increase the patient's body temperature and decrease their ﬂuid volume. Therefore, option a (ﬂuid restriction) would be appropriate for this patient.

Options b (administration of hypotonic IV ﬂuids) and d (administration of ion-exchange resin) would not be appropriate because they would increase the patient's ﬂuid volume rather than decrease it.

Option c (placement of an indwelling urinary catheter) may be appropriate to closely monitor the patient's urine output, which is an important indicator of their ﬂuid status. However, this alone would not be sufficient to manage the patient's hypothermia and ﬂuid volume excess.

A. 5.0 mEq/L B. 2.9 mEq/L C. 3.8 mEq/L D. 6.0 mEq/L

Correct Answer is B

Explanation

Furosemide is a loop diuretic that works by blocking the reabsorption of sodium and chloride in the ascending loop of Henle in the kidney, leading to increased urine output. However, this medication can also cause potassium loss through increased urinary excretion, which can lead to hypokalemia (low potassium level). Hypokalemia can cause confusion, weakness, and other neurological symptoms.

The normal range for serum potassium is 3.5 to 5.0 mEq/L. A potassium level of 2.9 mEq/L is below the normal range and is considered hypokalemic. Therefore, the nurse should correlate the client's confusion with the low potassium level and notify the healthcare provider to adjust the medication or provide potassium supplements if indicated.

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While assessing a patient who has just arrived in the post-anesthesia recovery unit (PACU) after a thyroidectomy, the nurse obtains this data. Which is the most important to communicate to the surgeon?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a patient with hypothermia and ﬂuid volume excess. Which of the following would be included in the plan of care?

Correct Answer is A

Explanation

A client is taking furosemide (Lasix), a diuretic. and becomes confused. Which potassium level does the nurse correlate with this condition?

Correct Answer is B

Explanation

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