A nurse is reinforcing teaching with a client who is to undergo a bone marrow aspiration. Which of the following statements should the nurse include in the teaching?
"You will need to fast for 2 hours before the procedure."
"You will have the bone marrow taken from your femur."
"You will not receive a local anesthetic agent for this procedure."
"I will hold pressure on the site after the procedure."
The Correct Answer is D
A. "You will need to fast for 2 hours before the procedure." Bone marrow aspiration typically does not require fasting. If the procedure involves sedation, the client may be instructed to fast for a certain period, but fasting is not a standard requirement for bone marrow aspiration.
B. "You will have the bone marrow taken from your femur." While the femur (thigh bone) can be a site for bone marrow aspiration, the most common site is the posterior iliac crest (the back of the pelvis). The nurse should clarify the exact site with the healthcare provider.
C. "You will not receive a local anesthetic agent for this procedure." Bone marrow aspiration is typically performed under local anesthesia to minimize discomfort at the site. The client will feel pressure during the procedure but should not experience pain due to the anesthesia.
D. "I will hold pressure on the site after the procedure." After a bone marrow aspiration, the nurse will apply pressure to the site to control any bleeding and help prevent hematoma formation. This is an important part of post-procedure care.
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Related Questions
Correct Answer is C
Explanation
A. "Plan to hire a home care aide to perform all of your ADLs.": Encouraging independence is vital for rehabilitation. Assistance should be provided only as needed.
B. "You will not become fatigued when you use assistive devices.": Using assistive devices can still be tiring; clients should be informed to take frequent breaks.
C. "Install grab bars in your shower to assist with your balance." Grab bars are essential for safety, as clients who have a CVA may have weakness or poor balance, increasing the risk of falls.
D. "Place a towel in the shower to prevent slipping.": Towels in the shower are not safe and can increase the risk of slipping. A non slip mat is a better alternative.
Correct Answer is ["D","E","F"]
Explanation
A. Fluid intake: While fluid balance is important, there is no specific information indicating that changes in fluid intake are an indicator of the client’s condition improving in this context.
B. Temperature: The client's temperature has increased from 38.3°C (101°F) on Day 1 to 39.2°C (102.5°F) on Day 4. An increase in temperature indicates a possible infection or ongoing inflammation and does not suggest an improvement in the client’s condition.
C. Wound findings: There are no documented wound findings in the given notes. Thus, wound findings are not applicable in determining whether the client’s condition has improved in this scenario.
D. Pain level: The client's pain level has decreased from 7 to 3, indicating improvement.
E. Report of nausea: The client reports feeling less nauseous and has not vomited since yesterday, which is a sign of improvement.
F. Bowel sounds: The bowel sounds are more regular and less high-pitched, suggesting improvement in gastrointestinal function.
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