A client who recently underwent a routine surgical procedure made a dinic appointment. To elicit the most information, which question is best for the nurse to ask this client?
"What brought you to the clinic?"
"Are you having any pain?"
"What type of surgery did you have?"
"When did your surgery take place?"
The Correct Answer is A
A. This open-ended question allows the client to describe the reason for their visit in their own words, which can provide a broad range of information about their current concerns or symptoms. It encourages the client to share specific issues or problems they are experiencing since the surgery, which could include pain, complications, or other concerns.
B. While this question is important for assessing one aspect of the client’s postoperative condition, it is somewhat narrow. It focuses specifically on pain, which is only one possible postoperative issue. This question does not capture other potential concerns such as functional problems, wound healing, or systemic symptoms.
C. Knowing the type of surgery is important for understanding the client’s medical background and specific postoperative considerations. However, this question may not provide immediate information about the client’s current condition or why they are seeking follow-up care.
D. This question helps establish a timeline and can be useful for understanding the postoperative phase and assessing healing progress. However, it does not directly address the client's current symptoms or concerns. Knowing the timing of the surgery alone does not provide comprehensive information about the client's present condition or reasons for the visit.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. A firm mass palpated at the bottom of the left rib cage can indicate an enlarged spleen, which is an abnormal finding. Splenomegaly may occur due to various conditions, including infections, liver disease, or blood disorders.
B. Rebound tenderness in the right upper quadrant is indicative of potential inflammation or irritation in the abdominal cavity, often associated with appendicitis or other conditions affecting the right lower quadrant. This finding is not specific to the spleen but rather to the general abdominal assessment and does not indicate an abnormal response related to spleen palpation.
C. Normally, the spleen is not palpable in most people. However, if the spleen is slightly enlarged, its tip may be palpable during deep palpation or when the client is asked to exhale forcefully. While this can be an abnormal finding, it may still fall within a range of normal variability depending on the clinical context.
D. McBurney's point is located in the right lower quadrant of the abdomen and is associated with the appendix. Pain at this location is indicative of potential appendicitis, not an abnormal finding related to spleen palpation. This finding does not provide information about the condition of the spleen.
Correct Answer is A
Explanation
A. Asking the client to swallow while palpating along the sides of the trachea helps in assessing the thyroid gland's size and mobility. The thyroid gland is located just below the larynx, and during swallowing, it moves upward, which can make it easier to palpate and identify any enlargement or nodules.
B. Palpating deeply and firmly might not be necessary and could be uncomfortable for the client. Gentle palpation is usually adequate for assessing the thyroid gland. Excessive force is not recommended as it may not yield additional information and could cause discomfort.
C. If the thyroid gland is not visible, documenting that it is normal without further assessment may not be accurate. The gland could be enlarged (goiter) or have other abnormalities that are not apparent on visual inspection alone. Accurate documentation should include findings from palpation and other assessment techniques.
D. Deferring the thyroid exam and focusing on signs of myxedema is not ideal in this situation. Myxedema is a severe form of hypothyroidism that can have various signs, but the immediate need is to assess the thyroid gland directly for goiter or other abnormalities. It is essential to perform a thorough examination and not rely solely on observation of symptoms that might appear later.
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