A client who is scheduled for surgery in a week tells the nurse doing the preoperative assessment about an allergy to bananas, kiwifruit, and latex products. Which action is most important for the nurse to take?
Select one:

Alert the surgery center about the latex allergy.

Notify the dietitian about the food allergies.

Ask whether the patient uses antihistamines to reduce allergic reactions,

Reassure the patient that all allergies are noted on the medical record.

Answer and Explanation

The Correct Answer is A

A. Clients with allergies to bananas, kiwifruit, avocados, and chestnuts are at higher risk for latex allergies due to cross-reactivity. Latex is commonly used in surgical gloves and equipment. Immediate notification of the surgery center allows them to use latex-free supplies and equipment, which is critical for preventing a life-threatening anaphylactic reaction.

B. While food allergies are important, they are not the priority in this surgical context. Preventing exposure to latex during surgery is more urgent and potentially life-saving.

C. This is not the priority action. While antihistamines may help manage minor allergies, latex exposure can cause anaphylaxis, which antihistamines cannot prevent.

D. Reassurance is important, but the critical action is to ensure the surgical team is aware and prepared, not just documentation.

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Correct Answer is B

Explanation

A. Increasing the client’s sodium intake is contraindicated. Sodium contributes to fluid retention, which can worsen ascites in clients with cirrhosis.
B. Decreasing the client’s fluid intake is correct. Fluid restriction is often recommended for clients with ascites to help control fluid accumulation in the abdominal cavity and reduce discomfort.
C. Increasing the client’s saturated fat intake is not advisable, as it can contribute to further liver damage and complications in clients with liver disease.
D. Decreasing the client’s carbohydrate intake is unnecessary unless blood glucose control is an issue. Clients with cirrhosis often need adequate carbohydrates for energy, especially since protein intake may be limited to prevent hepatic encephalopathy.

A. Penrose Drain B. Jackson-Pratt Drain C. T-Tube Drain D. Hemovac Drain

Correct Answer is D

Explanation

A. A Penrose drain is a passive, open drain made of soft rubber tubing that allows fluid to drain onto a dressing. It is not connected to a collection device, and it does not use suction.

B. A Jackson-Pratt (JP) drain is a closed-suction drain with a bulb-shaped reservoir, not a spring-loaded drum. It works via compression to create suction.

C. A T-tube is used specifically for bile drainage after gallbladder surgery or bile duct procedures. It is shaped like a "T" and does not involve a spring-loaded mechanism.

D. The Hemovac drain is a closed-suction drainage system that uses a spring-loaded drum to create suction. It is commonly used in postoperative settings (e.g., orthopedic or abdominal surgeries) to collect blood or fluid from surgical wounds and help prevent hematoma or seroma formation.

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A client who is scheduled for surgery in a week tells the nurse doing the preoperative assessment about an allergy to bananas, kiwifruit, and latex products. Which action is most important for the nurse to take? Select one:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is contributing to the plan of care for a client who has cirrhosis and ascites. Which of the following interventions should the nurse recommend for inclusion in the plan of care?

Correct Answer is B

Explanation

You receive a report from the PACU nurse concerning a patient who will be returning back to the unit in 15 minutes. You were advised that the patient has a spring loaded collection drum placed near the wound. Based on your knowledge, which type of drain does the patient have?

Correct Answer is D

Explanation

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A client who is scheduled for surgery in a week tells the nurse doing the preoperative assessment about an allergy to bananas, kiwifruit, and latex products. Which action is most important for the nurse to take?
Select one: