A nurse is caring for a client who had a cholecystectomy and has a T-tube drain. Which of the following actions should the nurse take?

Apply a transparent dressing to the drain site.

Clamp the tubing when the client ambulates.

Place the client into Fowler's position.

Secure the tubing to the client's gown.

Answer and Explanation

The Correct Answer is C

Choice A Reason: Applying a transparent dressing to the drain site is not an appropriate action for the nurse to take, as it may trap moisture and bacteria and increase infection risk.

Choice B Reason: Clamping the tubing when the client ambulates is not an appropriate action for the nurse to take, as it may cause bile accumulation and leakage and increase pressure and pain.

Choice C Reason: Placing the client into Fowler's position is an appropriate action for the nurse to take, as it helps to promote drainage and prevent reflux of bile into the liver.

Choice D Reason: Securing the tubing to the client's gown is not an appropriate action for the nurse to take, as it may cause tension and displacement of the drain and increase discomfort and bleeding.

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Correct Answer is A

Explanation

Choice A Reason: Buffalo hump and moon face are physical assessment findings that the nurse would expect to observe in a client with Cushing's syndrome, as they indicate fat redistribution and accumulation due to excess cortisol production.

Choice B Reason: Dry, scaly skin and cold intolerance are not physical assessment findings that the nurse would expect to observe in a client with Cushing's syndrome, but they may indicate hypothyroidism, which affects the metabolism and skin condition.

Choice C Reason: Dry, sticky mucous membranes and hypovolemia are not physical assessment findings that the nurse would expect to observe in a client with Cushing's syndrome, but they may indicate dehydration or diabetes insipidus, which affect the fluid balance and urine output.

Choice D Reason: Exophthalmos and tachycardia are not physical assessment findings that the nurse would expect to observe in a client with Cushing's syndrome, but they may indicate hyperthyroidism, which affects the eye protrusion and heart rate.

A. If I feel nervous or have tremors, I should only take half the dose. B. I can expect diarrhea, insomnia, and excessive sweating. C. I need to call my healthcare provider if my heart rate becomes fast. D. I should take the medication in the evening.

Correct Answer is C

Explanation

Choice A Reason: If I feel nervous or have tremors, I should not only take half the dose, but I should contact my healthcare provider, as these may indicate signs of overdose or hyperthyroidism.

Choice B Reason: I cannot expect diarrhea, insomnia, and excessive sweating, but these are possible side effects of overdose or hyperthyroidism.

Choice C Reason: I need to call my healthcare provider if my heart rate becomes fast, as this may indicate a serious adverse reaction or overdose of levothyroxine sodium.

Choice D Reason: I should not take the medication in the evening, but in the morning on an empty stomach at least 30 minutes before breakfast, as this ensures better absorption and prevents insomnia.

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A nurse is caring for a client who had a cholecystectomy and has a T-tube drain. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client admitted to a medical-surgical unit for surgery has a history of Cushing's syndrome. Which physical assessment finding would the nurse expect to observe?

Correct Answer is A

Explanation

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Correct Answer is C

Explanation

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