A nurse is caring for a client arriving to the unit following a cardiac catheterization with a right femoral insertion site. Which of the following is the nurse's priority action?
Assess the insertion site.
Keep the client NPO for 4 hr.
Keep the affected leg slightly flexed.
Elevate the head of the bed 45°.
The Correct Answer is A
A. Assess the insertion site: Assessing the insertion site for bleeding, hematoma, or signs of infection is the priority action because complications at the insertion site can occur post- procedure and require immediate attention.
B. Keep the client NPO for 4 hr: Keeping the client NPO is not typically necessary after a cardiac catheterization unless there are specific orders or complications.
C. Keep the affected leg slightly flexed: The affected leg should actually be kept straight to prevent bleeding from the insertion site.
D. Elevate the head of the bed 45°: The head of the bed should usually be kept flat or only slightly elevated to reduce the risk of bleeding from the femoral site.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Poorly coordinated care and nosocomial infections are examples of errors: Poorly coordinated care, such as miscommunication between healthcare providers or lack of continuity in care, and nosocomial infections (infections acquired in the healthcare setting) are examples of errors that can compromise patient safety and contribute to adverse events.
B. Handoff errors are not causes of adverse events: Handoff errors, including miscommunication during transitions of care, are significant contributors to adverse events in healthcare settings. Improper handoffs can lead to misunderstandings, delays in treatment, and errors in medication administration.
C. Medication errors are intentional: Medication errors are unintended and can occur due to various factors, including human error, system failures, and communication breakdowns. They are not intentional acts.
D. As many as 10% of medication errors are preventable: Medication errors are often preventable with the implementation of safety measures such as barcode scanning, medication reconciliation, and standardized protocols. The percentage of preventable medication errors may vary depending on the healthcare setting and the effectiveness of safety initiatives.
Correct Answer is C
Explanation
A. Docusate Sodium (Colace) is a stool softener and is not contraindicated in chronic renal disease.
B. Acetaminophen (Tylenol) is generally safe for use in chronic renal disease, but dosing adjustments may be necessary based on renal function.
C. Meperidine (Demerol) is contraindicated in clients with chronic renal disease because its metabolites can accumulate in renal impairment, leading to neurotoxicity and seizures. It is often replaced with alternative opioid analgesics like morphine or fentanyl in these patients.
D. Atorvastatin (Lipitor) is a statin medication used to lower cholesterol levels and is generally safe in chronic renal disease, although dosing adjustments may be needed depending on the severity of renal impairment.
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