A nurse is assessing a client who is post op following a thyroidectomy

Exhibits

Complete the sentence utilizing the provided options.

The nurse is assessing the client post-op and notes client is complaining of tingling of the finger-tips and assesses for
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. The nurse is aware if positive the client likely has
dropdown
related to
dropdown
during surgery

Answer and Explanation

The Correct Answer is {"dropdown-group-1":"E","dropdown-group-2":"A","dropdown-group-3":"E"}

The nurse is assessing the client post-op and notes the client is complaining of tingling of the fingertips and assesses for Target 1: Chvostek sign; the nurse is aware if positive, the client likely has Target 2: hypocalcemia related to Target 3: disruption or removal of the parathyroid during surgery.

Rationale:

Target 1: Chvostek sign - This is a clinical sign used to assess for neuromuscular excitability due to hypocalcemia. A positive Chvostek sign, which involves twitching of the facial muscles when tapping the facial nerve, indicates low calcium levels.
Target 2: Hypocalcemia - The tingling sensation in the fingertips can be a symptom of hypocalcemia, which is a common complication following thyroidectomy due to potential damage or removal of the parathyroid glands.
Target 3: Disruption or removal of the parathyroid during surgery - Parathyroid glands regulate calcium levels in the body. If these glands are disrupted or removed during thyroid surgery, it can lead to hypocalcemia.

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Correct Answer is B

Explanation

A. Turning the client onto their operative side could increase pressure on the eye and is not an appropriate first action.
B. Administering prescribed pain medication and antiemetic is essential to address the client's severe pain and nausea, which are priority concerns in the postoperative period.
C. While it may be necessary to notify the surgeon if symptoms persist, the immediate priority is to alleviate the client's discomfort.
D. Reassuring the client that these symptoms are normal is misleading; severe pain and nausea postoperatively should be addressed promptly.

A. Encourage fluid intake at and between meals. B. Cleanse the perineum from back to front. C. Offer the client the bedpan every 2 hours. D. Obtain a prescription for an indwelling urinary catheter.

Correct Answer is A

Explanation

A. Encouraging fluid intake at and between meals helps to dilute urine and can reduce the risk of urinary tract infections (UTIs) by promoting regular urination.
B. Cleansing the perineum should be done from front to back to prevent the introduction of bacteria from the rectal area to the urethra, so this option is incorrect.
C. Offering the bedpan every 2 hours may not be sufficient for individuals at risk for UTIs, as more frequent voiding can help prevent infection.
D. An indwelling urinary catheter increases the risk of urinary tract infections and should be avoided unless absolutely necessary; intermittent catheterization is generally preferred for those with spinal cord injuries to minimize this risk.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a client who has undergone a cataract extraction and during the early postoperative period is complaining of nausea and severe eye pain over the operative site. What should be the initial nursing action?

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Explanation

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Correct Answer is A

Explanation

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