A nurse is evaluating a client who had a left-sided cardiac catheterization with an upper extremity insertion site.
Which of the following actions should the nurse take?
Encourage the client to ambulate within 30 min following the procedure.
Keep the client NPO for at least 2 hr following the procedure.
Assess pulses in the client's affected arm.
Apply light pressure to the insertion site.
The Correct Answer is C
Choice A rationale
Encouraging the client to ambulate within 30 minutes following the procedure is not recommended as it could lead to complications such as bleeding or hematoma at the insertion site.
Choice B rationale
Keeping the client NPO for at least 2 hours following the procedure is not typically necessary and does not relate directly to the care required after a cardiac catheterization.
Choice C rationale
Assessing pulses in the client's affected arm is crucial to ensure that there is adequate blood flow and no compromise in circulation following the procedure.
Choice D rationale
Applying light pressure to the insertion site may help in preventing bleeding initially, but it is more critical to monitor for signs of bleeding or hematoma formation over time. .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Total parenteral nutrition (TPN) provides essential nutrients intravenously, allowing the bowel to rest and heal, which is important in the management of inflammatory bowel disease (IBD).
Choice B rationale
While reducing inflammation and controlling symptoms are important goals in IBD management, TPN is primarily used to provide nutrition and allow the bowel to rest.
Choice C rationale
Stimulating the bowel is not the purpose of TPN. TPN is used to give the digestive tract a break while ensuring the patient receives necessary nutrients.
Choice D rationale
Preventing malnutrition and promoting weight gain are secondary benefits of TPN, but the primary rationale is to provide nutrients while allowing the bowel to rest and heal.
Correct Answer is D
Explanation
Choice A rationale
Visible signs of bone healing on an X-ray would not be expected after Buck's traction. Healing takes longer to become visible on an X-ray.
Choice B rationale
Increased swelling and redness would indicate complications such as infection or thrombophlebitis, not the effectiveness of traction.
Choice C rationale
Improved range of motion would not typically be expected while Buck's traction is in place. The primary purpose is to reduce pain and immobilize the fracture.
Choice D rationale
Decrease in hip pain is a direct indicator of the effectiveness of Buck's traction in alleviating symptoms and preventing further injury to the fractured femur.
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