The nurse is monitoring a client with Cushing's disease in the postanesthesia care unit (PACU) after a hypophysectomy. Which intervention is most important for the nurse to include in the client's plan of care?
Maintain nasal packing.
Keep head of bed at 30°.
Provide frequent mouth care.
Monitor Intake and output.
The Correct Answer is C
A. Maintaining nasal packing may be important post-hypophysectomy to prevent bleeding or cerebrospinal fluid leaks. However, in the context of Cushing's disease, ensuring oral hygiene is
paramount due to increased risk of infection, especially if the patient is on corticosteroid therapy, which suppresses the immune system.
B. Keeping the head of the bed at 30° helps prevent complications such as cerebral edema and increased intracranial pressure. While this is important post-hypophysectomy, it's not specific to Cushing's disease or a priority over oral care.
C. Providing frequent mouth care is crucial in Cushing's disease due to increased cortisol levels leading to immunosuppression and susceptibility to infections. Additionally, glucocorticoid therapy can cause mucosal dryness and ulceration, necessitating meticulous oral hygiene.
D. Monitoring intake and output is essential postoperatively to assess fluid balance and renal function. While important, it's not the priority in this context compared to oral care, especially considering the risk of dehydration due to increased cortisol levels in Cushing's disease.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["0.2"]
Explanation
Step-by-step Calculation:
- We need to find the volume (in mL) of teriparatide that contains the desired dose of 60 mcg.
- Set up the proportion:
dose (mcg) / concentration (mcg/mL) = volume (mL)
- Fill in the known values:
- Dose (mcg): 60 mcg (as given in the problem)
- Concentration (mcg/mL): 750 mcg/2.4 mL (from the medication label)
- Solve for the volume:
- Multiply both sides of the proportion by the concentration to isolate the volume on the left:
- dose (mcg) = volume (mL) concentration (mcg/mL)
- Substitute the known values:
- 60 mcg = volume (mL) (750 mcg / 2.4 mL)
- Calculate the volume:
- Divide both sides by the concentration to solve for the volume:
- volume (mL) = 60 mcg / (750 mcg / 2.4 mL)
- Simplify:
- volume (mL) = (60 mcg 2.4 mL) / 750 mcg
- volume (mL) = 0.192 mL (approximately)
- Rounding (optional): The problem specifies rounding to the nearest tenth. Since 0.192 is closer to 0.2 than 0.1, the rounded volume is:
- volume (mL) = 0.2 mL (rounded to one decimal place)
Therefore, the nurse should administer 0.2 mL of teriparatide.
Correct Answer is C
Explanation
A. Wearing an N95 respiratory mask is not typically required for routine care of a toddler with respiratory syncytial virus unless performing procedures that generate aerosols.
B. Negative pressure rooms are generally reserved for patients with airborne infections like tuberculosis; respiratory syncytial virus does not typically require isolation in a negative pressure room.
C. Using a designated stethoscope helps prevent the spread of infection to other patients by avoiding cross-contamination.
D. Removing the disposable gown after leaving the toddler's room is appropriate for maintaining infection control but is not specific to caring for a toddler with respiratory syncytial virus.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.