Solutions - Chapter 37 - Kozier Erb's Fundamentals Nursing - 10 Ed

 

10TYK. The nurse plans to remove the client’s sutures. Which action demonstrates appropriate standards of care? Select all that apply.
1.  Use clean technique.
2.  Grasp the suture at the knot with a pair of forceps.
3.  Place the curved tip of the suture scissors under the suture as close to the skin as possible.
4.  Pull the suture material that is visible beneath the skin during removal.
5.  Remove alternate sutures first.
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1CTC. Mrs. Dodd is a 51-year-old client who is being cared for in the critical care unit following an automobile crash in which she suffered extensive traumatic injuries. Mrs. Dodd is connected to several monitoring devices, has an intubation tube and ventilator to assist her with respirations, and is receiving various pain and other medications.
Identify factors that place Mrs. Dodd at risk for the development of sensory deprivation or overload.
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1TYK. Which client is at greatest risk for experiencing sensory overload?
1.  A 40-year-old client in isolation with no family
2.  A 28-year-old quadriplegic client in a private room
3.  A 16-year-old listening to loud music
4.  An 80-year-old client admitted for emergency surgery
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2CTC. Mr. Teng is a 77-year-old client with a history of chronic obstructive pulmonary disease. Currently his respiratory condition is being Patrolled with medications and he is free of infection. He has just been transferred to the postanesthesia care unit following a hernia repair performed under spinal anesthesia. His blood pressure is 132/88 mmHg, pulse 84 beats/min, respirations 28/min, and tympanic temperature 36.5°C (97.8°F). He is awake and stable.
Speculate about why Mr. Teng’s surgeon and anesthesiologist decided to perform Mr. Teng’s surgery under regional anesthesia as opposed to general anesthesia.
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2TYK. A client who is having a mastectomy expresses sadness about losing her breast. Based on this information, the nurse would identify that the client is at risk for which nursing diagnosis?
1.  Disturbed Body Image
2.  Grieving
3.  Fear
4.  Ineffective Coping
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3CTC. Mr. Teng is a 77-year-old client with a history of chronic obstructive pulmonary disease. Currently his respiratory condition is being Patrolled with medications and he is free of infection. He has just been transferred to the postanesthesia care unit following a hernia repair performed under spinal anesthesia. His blood pressure is 132/88 mmHg, pulse 84 beats/min, respirations 28/min, and tympanic temperature 36.5°C (97.8°F). He is awake and stable.
What preparations were taken during the preoperative period to protect Mr. Teng from possible complications during and after his surgery?
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3TYK. Which statement by the client indicates that the preoperative teaching regarding gallbladder surgery has been effective?
1.  “I cannot eat or drink anything after midnight.”
2.  “I’m not going to cough after surgery because it might open my incision.”
3.  “I might have a stroke if I stop taking my anticoagulant.”
4.  “The nurse showed me how to contract and relax my calf muscles.”
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4CTC. Mr. Teng is a 77-year-old client with a history of chronic obstructive pulmonary disease. Currently his respiratory condition is being Patrolled with medications and he is free of infection. He has just been transferred to the postanesthesia care unit following a hernia repair performed under spinal anesthesia. His blood pressure is 132/88 mmHg, pulse 84 beats/min, respirations 28/min, and tympanic temperature 36.5°C (97.8°F). He is awake and stable.
How will Mr. Teng’s postoperative assessments differ from those of a person who received general anesthesia?
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4TYK. The nurse assesses a postoperative client who has a rapid, weak pulse; urine output of less than 30 mL7h; and decreased blood pressure. The client’s skin is cool and clammy. What complication should the nurse suspect?
1.  Thrombophlebitis
2.  Hypovolemic shock
3.  Pneumonia
4.  Wound dehiscence
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5CTC. Mr. Teng is a 77-year-old client with a history of chronic obstructive pulmonary disease. Currently his respiratory condition is being Patrolled with medications and he is free of infection. He has just been transferred to the postanesthesia care unit following a hernia repair performed under spinal anesthesia. His blood pressure is 132/88 mmHg, pulse 84 beats/min, respirations 28/min, and tympanic temperature 36.5°C (97.8°F). He is awake and stable.
What postoperative precautions are especially important to Mr. Teng in view of his chronic lung condition?
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5TYK. The client is most likely to require the greatest amount of analgesia for pain during which period?
1.  Immediately after surgery
2.  4 hours after surgery
3.  12 to 36 hours after surgery
4.  48 to 60 hours after surgery
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6TYK. A postop client who had abdominal surgery is holding a pillow against his abdomen during deep-breathing and coughing exercises. What term does the nurse use to describe this technique? _________
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8TYK. A postop client who had abdominal surgery is holding a pillow against his abdomen during deep-breathing and coughing exercises. What term does the nurse use to describe this technique? _________
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9TYK. The overall goal of nursing care during the intraoperative phase is the client’s ______________.
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