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.
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
The nurse will include the instruction "Offer the client the commode or urinal every 2 hours" in the teaching plan for the client's family. This approach is known as timed voiding and can help the client re-establish a regular pattern of urination. Option "a" promotes frequent voiding, which helps
prevent accidents and promotes bladder health. Option "b" is not a recommended approach and can lead to dehydration, urinary tract infections, and other complications. Option "c" is also not recommended since holding urine for extended periods can lead to bladder distention and increase the risk of urinary tract infections. Option "d" is also not recommended since catheterization should only be considered in specific cases where other options have failed or are not feasible.
Correct Answer is D
Explanation
Cushing syndrome is a hormonal disorder caused by prolonged exposure to high levels of cortisol hormone in the body. It can cause a variety of physical manifestations, including truncal obesity, thin arms, and legs, decreased axillary and pubic hair, hypertension, glucose intolerance, osteoporosis, and purple striae (stretch marks) on the abdomen.
Out of the options given, the nurse would expect to find purplish-red streaks on the abdomen as an additional manifestation of Cushing syndrome.
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