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?
Apply anti-embolic stockings.
Insert an NG tube.
Obtain consent for surgery.
Insert an indwelling urinary catheter.
The Correct Answer is C
Choice A rationale: Applying anti-embolic stockings may be important for preventing complications but is not the immediate priority.
Choice B rationale: Inserting an NG tube may be part of the preoperative preparation but is not the priority.
Choice C rationale: Obtaining consent for emergency surgery is the priority, ensuring that the client or legally authorized representative provides informed consent before the procedure.
Choice D rationale: Inserting an indwelling urinary catheter may be part of the preoperative preparation but is not the priority.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale: Petting the dog without permission may distract the service animal from its responsibilities.
Choice B rationale: Offering the dog a bowl of water may not be necessary unless requested by the client.
Choice C rationale: Commanding the dog to sit may interfere with its trained tasks and should be avoided without the handler's permission.
Choice D rationale: Consulting the client before approaching the service dog shows respect for the client and recognizes the dog's role as a working animal.
Correct Answer is A
Explanation
Choice A rationale: The perineal area should be washed with antimicrobial soap twice a day to prevent infections from bacteria or fungi that may be present in the genital or anal area.
Choice B rationale: Changing the water in the drinking glass every 4 hours is not a specific measure to prevent infection in an immunocompromised individual.
Choice C rationale: Washing the toothbrush in the dishwasher once a month may not be necessary, and more frequent cleaning may be advisable.
Choice D rationale: The pet's litter box should not be changed by the client, but by someone else who wears gloves and a mask. The litter box can contain fecal matter that may contain parasites or bacteria that can infect the client.
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