While completing the preoperative checklist, a patient who is almost ready for transport to the operating room states that he does not want to remove his wedding band. The nurse should:
ask a family member to take care of it.
tape it in place on his finger.
inform him that the hospital cannot be responsible for its loss.
remind him it must be removed, and lock it in the narcotic cabinet.
The Correct Answer is D
A. Ask a family member to take care of it. This is a reasonable option, but if a family member cannot be located, other procedures should be followed to secure the ring.
B. Tape it in place on his finger. Taping the ring on the finger is not advisable as it could create a risk of injury during the surgery and would not be secure. Rings should typically be removed or securely stored.
C. Inform him that the hospital cannot be responsible for its loss. While the hospital cannot be responsible for the loss of personal items, this does not address the need to remove or secure the ring before surgery for safety reasons.
D. Remind him it must be removed, and lock it in the narcotic cabinet. This is the most appropriate action. Jewelry should be removed prior to surgery to avoid injury, and it can be safely stored in a secure location such as the narcotic cabinet or a personal locker.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Atelectasis. Atelectasis is the collapse of alveoli due to hypoventilation, which commonly occurs postoperatively, especially in the lung bases.
B. Rales. Rales (crackles) are abnormal lung sounds associated with fluid in the alveoli, commonly seen in conditions like pneumonia or pulmonary edema, not atelectasis.
C. Rhonchi. Rhonchi are low-pitched sounds caused by mucus in the airways, often seen in chronic bronchitis or COPD.
D. Pneumothorax. Pneumothorax presents with absent breath sounds on one side, not bilaterally in the lung bases.
Correct Answer is C
Explanation
A. IV line patency: IV access is important for fluid and medication administration, but it is not the highest priority immediately postoperatively.
B. Urine output: Monitoring urine output is important for assessing kidney function and fluid balance, but airway management takes precedence.
C. Airway patency: The priority in the immediate postoperative period is maintaining a patent airway, as patients are at risk for respiratory complications such as obstruction, hypoxia, and aspiration due to anesthesia effects.
D. Wound drainage: Assessing wound drainage is necessary to monitor for excessive bleeding or infection, but it is not the top priority compared to airway patency.
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