A nurse is caring for a client who is postoperative following a complete thyroidectomy. Which of the following findings is the priority for the nurse to report to the provider?
Muscle twitching
Client report of nausea
Serosanguineous drainage
Client report of incisional pain
The Correct Answer is A
Choice A reason : Muscle twitching can be indicative of hypocalcemia, a common and serious complication following a complete thyroidectomy due to potential damage or removal of the parathyroid glands. Hypocalcemia requires immediate intervention to prevent more severe symptoms such as tetany or cardiac complications.
Choice B reason : While nausea is a common postoperative symptom, it is not typically as urgent as signs of hypocalcemia. However, persistent nausea should still be addressed as it can affect the client's comfort and nutritional intake.
Choice C reason : Serosanguineous drainage is expected to some extent after surgery, but if it is excessive or changes in character, it may indicate hemorrhage or infection, which would then become a priority.
Choice D reason : Incisional pain is also expected postoperatively. While pain management is important for recovery, it is not as immediately concerning as potential hypocalcemia unless the pain is severe or uncontrolled, suggesting complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: White rice is considered a low-potassium food, making it a suitable option for someone with chronic kidney disease who needs to limit their potassium intake. One cup of cooked white rice contains approximately 54 mg of potassium, which is significantly lower than the other options listed.
Choice B reason: Nonfat yogurt can vary in potassium content, but on average, a 1/2 cup serving may contain around 200 to 300 mg of potassium. While it is a nutritious choice, it contains more potassium than white rice and should be consumed in moderation by individuals with potassium restrictions.
Choice C reason: A medium baked potato with skin is high in potassium, with one potato containing over 900 mg of potassium. This makes it an unsuitable choice for someone who needs to limit their potassium intake due to chronic kidney disease.
Choice D reason: Peanut butter contains a moderate amount of potassium. Two tablespoons of peanut butter can have around 150 to 200 mg of potassium. Although it's not as high in potassium as a baked potato, it still contains more potassium than white rice.
Correct Answer is C
Explanation
The correct answer is: c. Wear a surgical mask when providing care to the client.
Choice A: Perform a Mantoux skin test on the client
The Mantoux skin test is used to screen for tuberculosis, not pertussis. Pertussis, also known as whooping cough, is a bacterial infection caused by Bordetella pertussis. The Mantoux test would not be relevant or helpful in diagnosing or managing pertussis.
Choice B: Assign the client to a negative-pressure airflow room
Negative-pressure airflow rooms are typically used for airborne infections such as tuberculosis, measles, or varicella. Pertussis is primarily spread through respiratory droplets, not airborne transmission, so a negative-pressure room is not necessary.
Choice C: Wear a surgical mask when providing care to the client
Wearing a surgical mask is appropriate when caring for a client with pertussis. Pertussis is spread through respiratory droplets, and wearing a mask helps prevent the transmission of the bacteria to healthcare workers and other patients.
Choice D: Recommend that the client’s family members receive antiviral therapy
Antiviral therapy is not effective against pertussis, which is a bacterial infection. Instead, antibiotics such as azithromycin or erythromycin are used to treat pertussis and prevent its spread. Therefore, recommending antiviral therapy would not be appropriate.
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