A nurse is assisting with the care of a client following a cerebral angiography. Which of the following actions should the nurse take?
Apply a warm pack to the client's puncture site.
Monitor for bleeding at the catheter site.
Replace the client's pressure dressing in 2 hr.
Encourage the client to ambulate in 1 hr.
The Correct Answer is B
A. Apply a warm pack to the client's puncture site. Applying a warm pack to the puncture site is not appropriate immediately following cerebral angiography. Cold compresses are generally recommended initially to reduce swelling and discomfort, while warmth may be used later as advised by the healthcare provider.
B. Monitor for bleeding at the catheter site. Monitoring for bleeding at the catheter site is a critical action after cerebral angiography. The nurse should assess the site frequently for signs of hematoma or excessive bleeding, which can indicate complications from the procedure.
C. Replace the client's pressure dressing in 2 hr. The pressure dressing should not be replaced without specific orders from the healthcare provider. The nurse should assess the dressing for any signs of bleeding or drainage and follow the protocol for dressing changes as indicated.
D. Encourage the client to ambulate in 1 hr. Early ambulation may not be safe immediately after cerebral angiography, especially if the client has undergone a procedure involving sedation or if there is a risk of complications. The nurse should follow the provider's orders regarding activity restrictions and assess the client's readiness for ambulation based on their condition and vital signs.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Encourage the family to be with the child during mealtimes. While having family present can provide support and create a positive mealtime atmosphere, it is not the first step in addressing poor dietary intake. Understanding the underlying reasons for the child's poor intake is more critical initially.
B. Instruct the family to praise the child when they eat. Encouraging praise can help create a positive association with eating, but this action is more effective after understanding the child's dietary habits and preferences.
C. Obtain the child's dietary history. Obtaining the child's dietary history is the most important first step. This allows the nurse to identify specific concerns, such as food preferences, patterns of intake, and any potential food allergies or intolerances. Understanding the child's current dietary habits is essential for developing an effective plan to improve nutritional intake.
D. Offer the child nutritious snacks between meals. Offering nutritious snacks can help increase caloric intake, but this should be done after assessing the child's dietary history to ensure that the snacks are appropriate and tailored to the child's needs and preferences.
Correct Answer is D
Explanation
A. Drain the tub water before the client gets out. Draining the tub water before the client gets out is not a recommended practice. Instead, the nurse should ensure that the client has a safe way to exit the tub while the water is still in it, as the water can provide support and stability when getting out.
B. Add bath oil to the water after the client gets into the tub. Adding bath oil to the water can create a slippery surface, increasing the risk of falls and injury. It is best to avoid bath oils, especially for clients who may have mobility issues or are at risk for falls.
C. Allow the client to remain in the bath for 30 min. While soaking in a tub can be relaxing, staying in the bath for too long can increase the risk of overheating or dehydration. A shorter duration may be more appropriate, depending on the client's condition and safety.
D. Check on the client every 10 min during the bath. Checking on the client regularly during the bath is essential for ensuring their safety. This practice allows the nurse to monitor for any signs of distress, difficulty, or the need for assistance, providing reassurance and promoting the client's well-being.
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