The nurse is assisting in the care of a patient after open-heart surgery. Which action by the other nurse would warrant intervention?
Providing the patient with a pillow to brace the incision
Instructing the patient to perform deep coughing every 30 minutes
Having the patient sit up and lean forward
Giving pain medication prior to coughing
The Correct Answer is B
Choice A reason: Providing a pillow to brace the incision is a recommended practice to support the incision during coughing or movement.
Choice B reason: Instructing the patient to perform deep coughing every 30 minutes is a standard postoperative care practice to prevent atelectasis.
Choice C reason: Having the patient sit up and lean forward can help with breathing and comfort after surgery.
Choice D reason: Giving pain medication prior to coughing is actually a recommended practice to reduce pain and facilitate effective coughing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Antiembolism stockings are designed to apply pressure to the lower legs, promoting blood circulation and preventing blood from pooling in the veins, which can lead to venous stasis.
Choice B reason: While antiembolism stockings aid in circulation, they do not replace the need for postoperative leg exercises, which are important for recovery.
Choice C reason: These stockings are not specifically used to prevent varicose veins; their primary purpose is to prevent deep vein thrombosis (DVT) in postoperative patients.
Choice D reason: The stockings are not primarily used for pain reduction; their main function is to improve venous return and prevent DVT.
Correct Answer is C
Explanation
Choice A reason: Provision of home care is not part of the immediate postoperative phase described during preoperative teaching.
Choice B reason: The decision for surgery until transfer to surgery is part of the preoperative phase, not the postoperative phase.
Choice C reason: Admission to the Post Anesthesia Care Unit (PACU) until recovery is the correct description of the postoperative phase, where the patient is monitored as they recover from anesthesia.
Choice D reason: Transfer to surgery until transfer to PACU describes the transition from preoperative to intraoperative phases, not the postoperative phase.
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