Which of the following techniques is correct for obtaining a wound culture specimen from a surgical site?
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Solution
Rolling a swab from the center outward is the right way to obtain a culture specimen from a wound.
Option A: Irrigating the wound washes away drainage, debris, and many of the colonizing or infecting microorganisms.
Option B: The outside of the wound and the dressing may be colonized with microorganisms that haven’t affected the wound, so specimens from these sites could give inaccurate results.
A patient has partial-thickness burns to both legs and portions of his trunk. Which of the following I.V. fluids is given first?
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Solution
Lactated Ringer’s solution replaces lost sodium and corrects metabolic acidosis, both of which commonly occur following a burn.
Option A: Albumin is used as adjunct therapy, not primary fluid replacement.
Option B: Dextrose isn’t given to burn patients during the first 24 hours because it can cause pseudodiabetes.
Option D: The patient is hyperkalemic from the potassium shift from the intracellular space to the plasma, so potassium would be detrimental.
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?
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Solution
A decreased hematocrit level is a sign of hematoma, a delayed complication of abdominal and vaginal hysterectomy.
Option B: Symptoms of hypovolemia include increased hematocrit and hemoglobin values.
Option C: Infection manifests with fever and high WBC count.
Option D: Symptoms of a PE include dyspnea, chest pain, cough, hemoptysis, restlessness, and signs of shock.
Patients with Type 1 diabetes mellitus may require which of the following changes to their daily routine during periods of infection?
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Solution
During periods of infection or illness, patients with Type 1 diabetes may need even more insulin to compensate for increased blood glucose levels.
Adequate fluid replacement and vasopressin replacement are objectives of therapy for which of the following disease processes?
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Solution
Maintaining adequate fluid and replacing vasopressin are the main objectives in treating diabetes insipidus.
Option A: Diabetes is a chronic condition associated with abnormally high levels of sugar (glucose) in the blood. Insulin produced by the pancreas lowers blood glucose.
Option C: Diabetic ketoacidosis is a result of severe insulin insufficiency.
Option D: An excess of antidiuretic hormone leads to SIADH, causing the patient to retain fluid.
Which of the following potentially serious complications could occur with therapy for hypothyroidism?
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Solution
Precipitation of angina or cardiac arrhythmia is a potentially serious complication of hypothyroidism treatment.
Option A: Acute hemolytic reaction is a complication of blood transfusions.
Option C: Retinopathy typically is a complication of diabetes mellitus.
Option D: Thrombocytopenia doesn’t result from treating hypothyroidism.
After a liver biopsy, place the patient in which of the following positions?
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Solution
Positioning the patient on his right side with the bed flat will splint the biopsy site and minimize bleeding. The other positions won’t do this and may cause more bleeding at the site or internally.
Which of the following factors should be the primary focus of nursing management in a patient with acute pancreatitis?
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Solution
Acute pancreatitis is commonly associated with fluid isolation and accumulation in the bowel secondary to ileus or peripancreatic edema. Fluid and electrolyte loss from vomiting is a major concern. Therefore, your priority is to manage hypovolemia and restore electrolyte balance.
Options A & D: Pain control and nutrition also are important, but not priority.
Option C: Patients are at risk for hyperglycemia, not hypoglycemia.
After surgical repair of a hip, which of the following positions is best for the patient’s legs and hips?
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Solution
After surgical repair of the hip, keep the legs and hips abducted to stabilize the prosthesis in the acetabulum.
When giving intravenous (I.V.) phenytoin, which of the following methods should you use?
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Solution
Phenytoin is compatible only with saline solutions.
Options A and B: You needn’t withhold additional anticonvulsants or use an in-line filter.
Option D: Dextrose causes an insoluble precipitate to form.