A nurse is assisting with the care of a client 2 hr postoperative following a cardiac catheterization. Which of the following actions should the nurse take?
Check the client's distal pulses in both legs.
Keep the client overnight.
Keep the client on bed rest for 12 hr.
Restrict the client's oral fluids.
The Correct Answer is A
A. Check the client's distal pulses in both legs:
Checking the client's distal pulses in both legs is crucial to ensure that there is adequate blood flow and no signs of arterial occlusion or complications from the catheterization. This is an important assessment to detect potential vascular complications, such as a hematoma or an arterial blockage.
B. Keep the client overnight:
Keeping the client overnight is not typically required for all cardiac catheterization procedures. The need for an overnight stay depends on the individual case and any complications or comorbidities. Routine catheterizations often allow for discharge on the same day with appropriate monitoring.
C. Keep the client on bed rest for 12 hr:
Keeping the client on bed rest for 12 hours is excessive. Typically, bed rest is required for 2 to 6 hours following the procedure to allow the puncture site to stabilize and reduce the risk of bleeding. The exact duration of bed rest depends on the approach used and the patient's condition.
D. Restrict the client's oral fluids:
Restricting the client's oral fluids is generally not appropriate. In fact, increasing fluid intake is often encouraged to help flush out the contrast dye used during the procedure and to prevent renal complications. Monitoring for fluid balance is important, but outright restriction is not typically indicated unless there is a specific medical reason.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. "This medication will help maintain a normal heart rhythm":
Warfarin is not typically used to maintain a normal heart rhythm in atrial fibrillation. It is primarily used for stroke prevention by anticoagulation.
B. "Warfarin helps prevent strokes in clients who have atrial fibrillation":
This statement is accurate. Warfarin is an anticoagulant medication that is commonly prescribed for clients with atrial fibrillation to reduce the risk of stroke by preventing blood clots from forming in the heart and traveling to the brain.
C. "Warfarin dissolves clots in the bloodstream":
Warfarin does not directly dissolve clots in the bloodstream. It works by inhibiting the production of clotting factors in the liver, thereby preventing the formation of new clots and reducing the risk of clot-related complications such as stroke.
D. "This medication slows the response of the ventricles to the fast atrial impulses":
This statement refers more to medications used for rate control in atrial fibrillation rather than warfarin. Warfarin does not directly affect the heart rate or the response of the ventricles to atrial impulses.
Correct Answer is ["A","D"]
Explanation
A. Review strategies to reduce sodium intake:
This educational method involves providing information and teaching the client specific strategies to reduce sodium intake, such as reading food labels, avoiding high-sodium processed foods, and choosing fresh fruits and vegetables. It engages the cognitive domain of learning as it focuses on acquiring knowledge and understanding of the topic.
B. Ask the client how they are feeling about starting a low sodium diet:
This educational method involves exploring the client's feelings and emotions regarding the low sodium diet. It primarily engages the affective domain of learning, which focuses on attitudes, beliefs, and feelings.
C. Observe the client choose low sodium foods:
This educational method involves observing the client's behavior and actions. It primarily engages the psychomotor domain of learning, which focuses on physical skills and actions.
D. Discuss the physiology of hypertension with the client:
This educational method involves explaining the underlying physiology of hypertension, including factors such as sodium intake, blood pressure regulation, and cardiovascular health. It engages the cognitive domain of learning as it focuses on acquiring knowledge and understanding of the physiological processes involved in hypertension.
E. Encourage the client to share their thoughts in a support group:
This educational method involves providing opportunities for the client to share their thoughts and experiences with others in a support group setting. It primarily engages the affective domain of learning, which focuses on attitudes, beliefs, and feelings.
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