A nurse in an emergency department is preparing a client for emergency surgery. The
client's blood alcohol level is 180 mg/dL. Which of the following actions is the nurse's priority?
Obtain consent for surgery.
Insert an indwelling urinary catheter.
Apply antiembolic stockings.
Insert an NG tube.
The Correct Answer is A
The nurse's priority is to ensure that the client has given informed consent for the surgery, which requires that the client is competent and understands the risks and benefits of the procedure. A client with a high blood alcohol level may not have the mental capacity to consent and may need a legal representative or a court order to proceed with the surgery.
The other actions are important but not as urgent as obtaining consent.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A history of inflammatory bowel disease, such as Crohn's disease or ulcerative colitis, is a risk factor for colorectal cancer . These conditions cause chronic inflammation and damage to the cells lining the colon and rectum, which may increase the likelihood of DNA mutations and cancer development. A diet high in fiber may help lower the risk of colorectal cancer by promoting regular bowel movements and reducing exposure to toxins. Age 46 years is not a significant risk factor, as most cases of colorectal cancer occur in people older than 50. BMI of 24 is within the normal range and does not indicate obesity, which is another risk factor for colorectal cancer.
Correct Answer is B
Explanation
A WBC count of 20,000/mm3 indicates infection and inflammation, which is expected in osteomyelitis. Long-term IV antibiotic therapy is a common treatment for osteomyelitis and may require a referral to avoid peripherl thrombophlebitis. Furosemide is a diuretic that may be prescribed for clients who have fluid retention or hypertension, which are not related to osteomyelitis. A HbA1c of 6% indicates good glycemic control for a client with type 2 diabetes mellitus, which can help prevent complications and infections.
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