A client who is fully awake after a gastroscopy asks the nurse for something to drink.
After confirming that liquids are allowed, which assessment action should the nurse consider a priority before offering oral intake?
Provide thickened fluids with a straw.
Listen to bilateral lung and bowel sounds.
Check the client's Hypoglossal nerve and Vestibulocochlear cranial nerve function.
Check the client's Glossopharyngeal nerve and Vagus cranial nerve function.
The Correct Answer is D
Choice A rationale: Providing thickened fluids with a straw is more related to swallowing difficulties and is not the priority in this context.
Choice B rationale: While assessing lung and bowel sounds is important, it's not directly related to offering oral intake after a gastroscopy.
Choice C rationale: Assessing the Hypoglossal nerve and Vestibulocochlear cranial nerve function isn't directly related to offering oral intake post-gastroscopy.
Choice D rationale: Checking the client's Glossopharyngeal nerve and Vagus cranial nerve function is crucial as these nerves play roles in swallowing, taste, and the gag reflex, which are important before allowing oral intake post-gastroscopy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D","E"]
Explanation
Choice A rationale: A/V fistula assessment is not concerning because a positive bruit and thrill indicate adequate blood flow through the fistula. A dry dressing with scant amount of blood is expected after hemodialysis.
Choice B rationale: The client's low blood pressure could indicate hypotension, which can be critical, especially after hemodialysis. It may contribute to the client's reported dizziness and fatigue.
Choice C rationale: The client’s pulse is irregular which may indicate cardiac arrhythmia. Choice D rationale: Anuria, the absence of urine output, is a significant concern. It could indicate kidney dysfunction or inadequate clearance of waste products, which may have implications following hemodialysis.
Choice E rationale: Oxygen saturation at 92% is relatively low. While the client is alert and oriented, a low oxygen saturation level may indicate potential respiratory compromise or inadequate oxygenation.
Choice F rationale: Temperature is not concerning because it is within normal range.
Choice G rationale: Neurological assessment is not concerning because the client is alert and oriented. The dizziness is likely related to the hypotension and will resolve once the blood pressure is stabilized.
Correct Answer is A
Explanation
Choice A rationale: Yeast vaginitis, commonly known as a yeast infection, is typically caused by an overgrowth of Candida albicans, a type of fungus. Candida albicans overgrowth can lead to symptoms like white, thick discharge and itching in the vaginal area.
Choice B rationale: Lactobacillus acidophilus is a bacterium associated with maintaining vaginal health rather than causing yeast infections.
Choice C rationale: Escherichia coli is a bacteria that can cause different types of infections but are not typically associated with yeast vaginitis.
Choice D rationale: Neisseria gonorrhoeae is a bacteria and does not cause yeast vaginitis despite having similar presentation such as pus discharge per vaginally.
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