A nurse is caring for a client diagnosed with lung carcinoma and scheduled for a left pneumonectomy. The nurse should prioritize which nursing Intervention in the immediate postoperative period?
Repositioning in bed.
Use of the incentive spirometer.
Application of antiembolism stockings.
Chest tube and pleura-vac assessment.
The Correct Answer is D
A. Repositioning in bed: While repositioning the client is important for comfort and preventing complications such as pressure ulcers, it is not the top priority immediately after a pneumonectomy. Proper positioning can help improve respiratory function, but ensuring the stability and function of chest drainage systems takes precedence in the immediate postoperative period.
B. Use of the incentive spirometer: Encouraging the use of an incentive spirometer is crucial for promoting lung expansion and preventing atelectasis. However, it is essential first to ensure that the client’s chest tube is functioning properly and that there are no complications from the surgery. While this intervention is important, it follows the need to assess the chest tube.
C. Application of antiembolism stockings: While applying antiembolism stockings is a good practice to prevent venous thromboembolism, it is not the highest priority in the immediate postoperative period. Other assessments and interventions, such as monitoring respiratory status and chest tube function, are more critical in this early stage after surgery.
D. Chest tube and pleura-vac assessment: This is the priority nursing intervention in the immediate postoperative period. After a pneumonectomy, monitoring the chest tube's placement, drainage output, and function is vital for ensuring that the pleural space is adequately drained and that there are no complications such as pneumothorax or hemothorax. This assessment is crucial for maintaining respiratory function and overall stability in the postoperative client.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Standard: While a standard resume format includes basic information about education and experience, it may not effectively address the nurse's multiple moves and varied positions, potentially raising concerns about stability and commitment.
B. Functional: This resume type is most appropriate for the nurse in this situation as it focuses on skills and experiences rather than a chronological work history. This format allows the nurse to highlight relevant skills gained in different positions without emphasizing the frequent changes in employment, which could be beneficial in presenting a cohesive professional narrative.
C. Sequence: This term is less commonly used in resume types and may not provide clarity in presenting qualifications or experiences.
D. Chronological: While this format lists experiences in reverse chronological order, it may draw attention to the frequent changes in positions and locations, which could raise red flags for potential employers regarding the nurse's commitment and stability in a job.
Correct Answer is B
Explanation
A. Advocacy: Advocacy involves representing the interests and needs of individual patients or groups within the healthcare system. While the nurse's actions may indirectly benefit patients by improving care standards, the focus here is on systemic changes rather than individual patient representation. Advocacy often involves lobbying for resources, policy changes, or addressing ethical concerns on behalf of patients, which is not the primary goal of the actions taken in this scenario.
B. Quality improvement: This term best describes the nurse's actions as it focuses on enhancing healthcare practices and patient outcomes through systematic efforts. By identifying the increase in pressure injuries and collaborating with management to implement a new policy, the nurse is actively participating in a quality improvement initiative aimed at reducing risks and improving care protocols in the ICU. This approach reflects a commitment to continuous improvement in patient safety and care standards, aligning with best practices in healthcare.
C. Case Management: Case management primarily involves coordinating care for individual patients, ensuring they receive appropriate services, and managing their healthcare journey. While the nurse may address pressure injuries at the unit level, the actions taken are broader and not confined to individual patient care. Case management emphasizes individualized care plans and resource allocation rather than addressing systemic issues affecting a group of patients in the ICU.
D. Collaboration: Collaboration refers to working together with others, such as colleagues and management, to achieve common goals in patient care. While the nurse did collaborate with the manager to develop and implement the new policy, collaboration alone does not capture the proactive approach taken to address the increase in pressure injuries. It emphasizes teamwork but lacks the focus on systematic quality enhancement that characterizes quality improvement efforts, which aim to implement lasting changes in practices and outcomes.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.
