A nurse is preparing a client for an elective mastectomy. The client is wearing a plain gold wedding band. Which of the following is an appropriate procedure for taking care of this client's ring?
Place the client's ring in the facility safe.
Place the ring in the bag with the client's clothing
Tape the ring securely to the client's finger
Agree to keep the ring for the client until after surgery.
The Correct Answer is A
A. Placing the client's ring in the facility safe ensures that it is securely stored and prevents loss or misplacement, which is standard procedure for valuable personal items before surgery.
B. Placing the ring in the bag with the client’s clothing is not secure, as it increases the risk of loss or theft.
C. Taping the ring to the client’s finger is not ideal because jewelry should generally be removed before surgery to prevent complications such as swelling, circulation issues, or electrical burns from cautery equipment.
D. Keeping the ring for the client is inappropriate because staff should not personally hold onto a client’s valuables. Instead, valuables should be properly documented and stored per facility policy.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Collaborative, user-edited websites might contain varying levels of accuracy and reliability regarding medical information, making them less suitable for obtaining specific prevalence data.
B. An evidence-based nursing journal is a reliable source of information that often includes statistical data, prevalence rates, and updated research on various medical conditions, including Tay-Sachs disease.
C. The facility's case manager might have general information but may not provide specific prevalence rates for Tay-Sachs disease.
D. While the client's health care provider might have knowledge about Tay-Sachs disease, their primary focus during a clinical encounter might be the client's immediate care needs rather than providing statistics on disease prevalence.
Correct Answer is D
Explanation
Rationale for A: An open fracture of the femur is serious and requires prompt treatment, but it does not typically indicate an immediate life threat compared to other conditions.
Rationale for B: Periorbital ecchymosis can indicate facial trauma, but it is not necessarily life-threatening and would not be prioritized as emergent.
Rationale for C: A deep partial thickness burn on the lower extremities is significant and requires treatment, but unless the burn covers a large area or is complicated by other factors, it is not the most critical issue compared to respiratory or cardiovascular threats.
Rationale for D: An asymmetrical thorax may suggest a possible pneumothorax or other significant respiratory issue, which could lead to respiratory distress or failure. This client should be tagged as emergent due to the potential for rapid deterioration.
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