While caring for a client one day following a thyroidectomy, the practical nurse (PN) notes that the client's voice is hoarse. What action should the PN take?
Notify the unit charge nurse of the finding.
Administer humidified oxygen per nasal cannula.
Obtain a cup of ice chips for the client.
Ensure that the drainage device is compressed.
The Correct Answer is A
Hoarseness or voice changes after thyroidectomy can be indicative of injury or irritation to the recurrent laryngeal nerve, which is responsible for controlling the vocal cords. This is a potential complication of the surgery and should be reported to the charge nurse or healthcare provider for further evaluation and management.
B. Administer humidified oxygen per nasal cannula: This option is not appropriate for addressing hoarseness in a client following a thyroidectomy. Hoarseness after a thyroidectomy is typically related to vocal cord injury or irritation, and providing humidified oxygen would not directly address this issue. It is important to notify the charge nurse or healthcare provider for further evaluation and management.
C. Obtain a cup of ice chips for the client: Providing ice chips is not the appropriate action for hoarseness following a thyroidectomy. Ice chips are typically used to provide hydration and comfort to clients, but they do not directly address the underlying cause of hoarseness, which in this case may be vocal cord injury or irritation. It is important to notify the charge nurse or healthcare provider for appropriate evaluation and management.
D. Ensure that the drainage device is compressed: While ensuring proper compression of a drainage device is important for preventing complications such as bleeding or infection, it is not directly related to the client's hoarseness. Hoarseness after a thyroidectomy is more likely related to vocal cord injury or irritation, and notifying the charge nurse or healthcare provider is necessary for further assessment and management.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
This is the finding that the PN should document as evidence that the amount of insulin is inadequate for the client with type 1 diabetes mellitus. Consecutive evening serum glucose greater than 260 mg/dL indicates hyperglycemia, which means that the client's blood sugar is too high and not well controlled by the insulin dose. The PN should report this finding to the healthcare provider and expect a possible adjustment in the insulin regimen.
Correct Answer is D
Explanation
Choice A reason:
Instructing the UAP in the correct removal of contaminated gloves focuses only on one aspect of the PPE removal process. While it is important to remove gloves correctly to prevent contamination, this choice does not address the comprehensive handling of all isolation attire. Proper PPE removal involves multiple steps, including the removal of gowns, masks, and gloves in a specific order to minimize the risk of contamination.
Choice B reason:
Reminding the UAP to remove the gown before removing gloves addresses part of the PPE removal process but not the entire procedure. The correct sequence for removing PPE is crucial to prevent self-contamination. However, this choice does not ensure that all steps are followed correctly. The PN needs to confirm that the UAP understands and correctly performs the entire process, not just one step.
Choice C reason:
Advising the UAP to remove the mask after exiting the room is incorrect because masks should be removed before leaving the isolation room to prevent contamination of the environment outside the isolation area. Droplet precautions require that masks be removed inside the room to contain any infectious agents within the isolation area. This choice could lead to the spread of infection if not followed correctly.
Choice D reason:
Confirming that the UAP has correctly handled the isolation attire ensures that all steps in the PPE removal process are followed correctly. This comprehensive approach helps maintain infection control standards and prevents the spread of infectious agents. By verifying that the UAP has correctly removed and disposed of all PPE, the PN ensures that the UAP adheres to proper protocols, thereby protecting both the healthcare workers and other clients.
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