Four hours after rhinoplasty, a client is swallowing repeatedly. Which priority action should the practical nurse (PN) take?

Evaluate return of gag reflex.

Demonstrate relaxation techniques.

Use penlight to assess pharynx for bleeding.

Administer intravenous analgesic per PRN protocol.

Answer and Explanation

The Correct Answer is C

Choice A reason: Evaluating the return of the gag reflex is important for assessing a client's ability to protect their airway and for readiness to eat or drink after surgery. However, it is not the immediate priority when a client is repeatedly swallowing, which can indicate bleeding.
Choice B reason: Demonstrating relaxation techniques can be beneficial for managing pain and anxiety, but it does not address the immediate concern of potential postoperative bleeding in a client who is repeatedly swallowing.
Choice C reason: Using a penlight to assess the pharynx for bleeding is the priority action. Repeated swallowing after rhinoplasty can indicate bleeding, and assessing the pharynx allows the nurse to identify and address any postoperative hemorrhage promptly.
Choice D reason: Administering an intravenous analgesic per PRN protocol may help manage pain, but it is not the priority action. The primary concern is to check for potential bleeding, which is indicated by the repeated swallowing.

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Correct Answer is A

Explanation

Choice A reason: Sputum is the most appropriate specimen to collect prior to the initiation of antibiotic therapy in a client with suspected pneumonia. Sputum cultures can help identify the specific bacteria or other pathogens causing the infection, allowing for targeted antibiotic therapy. Collecting the sputum sample before starting antibiotics ensures that the culture results are not influenced by the medication, leading to more accurate identification of the causative agent and more effective treatment.
Choice B reason: Urine is not the appropriate specimen to collect for diagnosing pneumonia. While urine cultures can be useful for diagnosing urinary tract infections or detecting certain pathogens through urine antigen tests, they are not relevant to identifying the etiology of a respiratory infection like pneumonia. The focus should be on obtaining samples directly from the respiratory system.
Choice C reason: A throat smear can be useful for diagnosing upper respiratory tract infections, such as strep throat, caused by Group A Streptococcus. However, it is not the most relevant test for diagnosing pneumonia, which affects the lower respiratory tract. A sputum sample is more appropriate for identifying the pathogens responsible for pneumonia.
Choice D reason: Blood cultures can be useful for detecting bacteremia or septicemia, especially in severe cases of pneumonia where the infection has spread to the bloodstream. However, they are not the primary method for identifying the specific cause of pneumonia. Blood cultures are typically used in conjunction with other tests, such as sputum cultures, to provide a comprehensive diagnosis.

A. It detects and maps electrical activity in areas of the brain. B. It uses X-rays and a computer to produce pictures of organs. C. It records eye and muscle movements in response to sounds. D. It graphs electrical impulses to show how the heart is functioning.

Correct Answer is D

Explanation

Choice A reason: This describes an electroencephalogram (EEG), not an ECG. An EEG detects and maps electrical activity in areas of the brain, which is useful for diagnosing conditions such as epilepsy and other brain disorders.
Choice B reason: This describes a computed tomography (CT) scan. A CT scan uses X-rays and a computer to produce detailed images of internal organs and structures. It is not related to the electrical activity of the heart.
Choice C reason: This describes an electromyography (EMG) test or an auditory brainstem response (ABR) test. EMG records electrical activity in muscles, while ABR measures eye and muscle responses to sounds to evaluate the auditory pathways in the brainstem. Neither of these tests is related to recording heart function.
Choice D reason: A 12-lead ECG graphs the electrical impulses generated by the heart as it beats. This test helps evaluate the heart's rhythm, detect any abnormalities, and diagnose various heart conditions such as arrhythmias, myocardial infarctions, and other cardiac issues. By capturing the electrical activity from different angles, the ECG provides a comprehensive picture of the heart's functioning.

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Four hours after rhinoplasty, a client is swallowing repeatedly. Which priority action should the practical nurse (PN) take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client is admitted with the diagnosis of possible pneumonia, and laboratory studies are prescribed to rule out the etiology. Which specimen should the practical nurse (PN) collect prior to the beginning of antibiotic therapy?

Correct Answer is A

Explanation

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Correct Answer is D

Explanation

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