A nurse is caring for a school-age child who is 2 hr postoperative following cardiac catheterization.
The nurse observes blood on the child’s dressing.
Which of the following actions should the nurse take?
Apply intermittent pressure 2.5 cm (1 in) above the percutaneous skin site.
Apply intermittent pressure 2.5 cm (1 in) below the percutaneous skin site.
Apply continuous pressure 2.5 cm (1 in) below the percutaneous skin site.
Apply continuous pressure 2.5 cm (1 in) above the percutaneous skin site.
The Correct Answer is D
This is because bleeding after a cardiac catheterization is a possible complication that can occur when a catheter is inserted into an artery in the groin or arm to examine the heart. Bleeding can drip or spurt from the puncture site, or form a lump under the skin called a hematoma. Applying continuous pressure above the site can help stop the bleeding and prevent hematoma formation.
Choice A is wrong because applying intermittent pressure 2.5 cm (1 in) above the percutaneous skin site may not be enough to control the bleeding and may increase the risk of hematoma.
Choice B is wrong because applying intermittent pressure 2.5 cm (1 in) below the percutaneous skin site may not be effective and may cause more damage to the artery.
Choice C is wrong because applying continuous pressure 2.5 cm (1 in) below the percutaneous skin site may also be ineffective and harmful to the artery.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","E"]
Explanation
The correct statements that indicate an understanding of discharge teaching for a client recovering from pancreatitis are:
✅ C. "I will eat small, frequent meals." This is recommended to reduce pancreatic stimulation and aid digestion.
✅ E. "I will notify my provider if my urine is dark." Dark urine may indicate worsening jaundice or liver involvement, which requires medical attention.
❌ A. "I will eat fish for dinner at least twice per week." While fish can be part of a healthy diet, the key dietary advice for pancreatitis is to eat low-fat meals. Fatty fish may not be appropriate unless specifically recommended.
❌ B. "I will limit my morning coffee to no more than two cups." Caffeine is not directly contraindicated, but the focus is more on avoiding alcohol and fatty foods. This statement doesn’t reflect core discharge teaching.
❌ D. "I should expect my bowel movements to be pale in color." Pale stools may indicate bile duct obstruction or liver dysfunction and should be reported, not expected.
Correct Answer is A
Explanation
This statement indicates an understanding of the teaching because it reflects the principle of supply and demand in breastfeeding. The more the baby stimulates the breast, the more milk the mother will produce.
Choice B is wrong because manually expressing milk will not decrease the milk supply. In fact, it can help increase the milk supply by removing more milk from the breast and signaling the body to make more.
Choice C is wrong because the breast is not emptied after 5 to 10 minutes of feeding. The baby should be allowed to nurse until they are satisfied and show signs of fullness, such as releasing the nipple, falling asleep, or turning away from the breast. The average duration of a feeding session can vary from 10 to 45 minutes.
Choice D is wrong because the baby should not always start on the same breast when feeding. The mother should alternate which breast she offers first to ensure both breasts are stimulated and drained equally.
This can help prevent engorgement, mastitis, and low milk supply. A simple way to remember which breast to start with is to wear a bracelet or a clip on the bra strap on the side that needs to be offered next.
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.
