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1.Nurse Betty is assigned to the following clients. The client that the nurse would see first after endorsement?
- A 34 year-old post operative appendectomy client of five hours who is complaining of pain.
- A 44 year-old myocardial infarction (MI) client who is complaining of nausea.
- A 26 year-old client admitted for dehydration whose intravenous (IV) has infiltrated.
- A 63 year-old post operative’s abdominal hysterectomy client of three days whose incisional dressing is saturated with serosanguinous fluid.
2.Nurse Cecilia is caring for a client who has undergone a vaginal hysterectomy. The nurse avoids which of the following in the care of this client?
- Elevating the knee gatch on the bed
- Assisting with range-of-motion leg exercises
- Removal of antiembolism stockings twice daily
- Checking placement of pneumatic compression boots
3. Linda, A 30 year old post hysterectomy client has visited the health center. She inquired about BSE and asked the nurse when BSE should be performed. You answered that the BSE is best performed:
- 7 days after menstruation
- At the same day each month
- During menstruation
- Before menstruation
4.After a mastectomy or hysterectomy, clients may feel incomplete as women. The statement that should alert nurse Gina to this feeling would be:
- “I can’t wait to see all my friends again”
- “I feel washed out; there isn’t much left”
- “I can’t wait to get home to see my grandchild”
- “My husband plans for me to recuperate at our daughter’s home”
5. When planning care with a client during the postoperative recovery period following an abdominal hysterectomy and bilateral salpingo-oophorectomy, nurse Frida should include the explanation that:
- Surgical menopause will occur
- Urinary retention is a common problem
- Weight gain is expected, and dietary plan are needed
- Depression is normal and should be expected
6.Which of the following statements defines laparoscopic myomectomy—an alternative to hysterectomy for the treatment of excessive bleeding due to fibroids?
- Removal of fibroids through a laparoscope inserted through a small abdominal incision.
- Cauterization and shrinking of fibroids using a laser or electrical needles.
- Coagulation of the fibroids using electrical current.
- Resection of the fibroids using a laser through a hyserscope passed through the cervix.
7. The nursing assistant is assigned to give Ms. Bailey, who has had an abdominal hysterectomy, a sitz bath. She is instructed to use the special sitz bath tub. She asks the nurse why the regular bath tub cannot be used. The most correct reply is based on the fact that a regular bath tab:
- Is more slippery and is dangerous when used for surgical clients
- Cannot supply water that is of the desired temperature for this procedure
- Applies heat to the legs and alters the desired effect of heat directed to the pelvic region
- Cannot be kept as clean as a special sitz bath tub
8. Following a total abdominal hysterectomy Ms. Sara Fleming develops a slightly elevated temperature and swelling in the right call of her leg. The physician prescribes warm moist compresses for the client’s affected leg. Which of the following nursing actions is correct when applying the warm moist compress? The nurse:
- Heats the water to 120°F
- Uses a sterile technique
- Inspect the skin every 4 hours
- Covers the wet gauze with a towel
9. A male patient undergoes a total abdominal hysterectomy. When assessing the patient 10 hours later, the nurse identifies which finding as an early sign of shock?
- Pale, warm, dry skin
- Heart rate of 110 beats/minute
- Urine output of 30 ml/hour
10. On a follow-up visit after having a vaginal hysterectomy, a 32-year-old patient has a decreased hematocrit level. Which of the following complications does this suggest?
- Pulmonary embolus (PE).
Answers & Rationales
1.B. A 44 year-old myocardial infarction (MI) client who is complaining of nausea. Nausea is a symptom of impending myocardial infarction (MI) and should be assessed immediately so that treatment can be instituted and further damage to the heart is avoided.
2. A. Elevating the knee gatch on the bed . The client is at risk of deep vein thrombosis or thrombophlebitis after this surgery, as for any other major surgery. For this reason, the nurse implements measures that will prevent this complication. Range-of-motion exercises, antiembolism stockings, and pneumatic compression boots are helpful. The nurse should avoid using the knee gatch in the bed, which inhibits venous return, thus placing the client more at risk for deep vein thrombosis or thrombophlebitis.
3. B. At the same day each month
4. B. “I feel washed out; there isn’t much left”. The client’s statement infers an emptiness with an associated loss.
5. A. Surgical menopause will occur. When a bilateral oophorectomy is performed, both ovaries are excised, eliminating ovarian hormones and initiating response.
6. A. Removal of fibroids through a laparoscope inserted through a small abdominal incision. Laparoscopic myomectomy is the removal of fibroids through a laparoscope inserted through a small abdominal incision.
- Laparoscopic myolysis is the procedure in which a laser or electrial needles are used to cauterize and shrink the fibroid.
- Laparoscopic cryomyolysis is the procedure in which electric current is used to coagulate the fibroids.
- Hysteroscopic resection of myomas is the procedure in which a laser is used through a hyserscope passed through the cervix; no incision or overnight stay is needed.
7. C. Applies heat to the legs and alters the desired effect of heat directed to the pelvic region
8. D. Covers the wet gauze with a towel
9. A. Restlessness. Early in shock, hyperactivity of the sympathetic nervous system causes increased epinephrine secretion, which typically makes the patient restless, anxious, nervous, and irritable. It also decreases tissue perfusion to the skin, causing pale, cool clammy skin. An above-normal heart rate is a late sign of shock. A urine output of 30 ml/hour is within normal limits.
10. A. Hematoma. A decreased hematocrit level is a sign of hematoma, a delayed complication of abdominal and vaginal hysterectomy. Symptoms of hypovolemia include increased hematocrit and hemoglobin values. Symptoms of a PE include dyspnea, chest pain, cough, hemoptysis, restlessness, and signs of shock.