The nurse receives orders for postural drainage using Trendelenburg's position. On which patients should the nurse question the order? (Select all that apply.)
a. Patient with a history of gastroesophageal reflux disease (GERD)
b. Postsurgical patient with a distended abdomen
c. Patient with blood pressure of 180/100
d. Patient with bronchiectasis on chest x-ray
A, B, C
Trendelenburg's position is contraindicated for uncontrolled hypertension, distended abdomen, esophageal surgery, recent gross hemoptysis, and uncontrolled airway at risk for aspiration. When patients have a risk for or history of GERD, the head-down position should not be used.
Bronchiectasis is an indication for postural drainage.
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The patient's wound is being treated with vacuum-assisted wound closure (negative pressure therapy, or VAC)
The nurse notices that the edge of the dressing is loose and torn, the foam in the wound has expanded, and wound drainage is leaking through the loose edge. What is the best nursing action? A) Reinforce dressing with additional foam packing. B) Reinforce transparent adhesive dressing. C) Discontinue suction on the wound to prevent maceration. D) Completely redress the wound with new materials.
Which action will the nurse take when performing ear irrigation for a patient with cerumen impaction?
a. Assist the patient to a supine position for the irrigation. b. Fill the irrigation syringe with body-temperature solution. c. Use a sterile applicator to clean the ear canal before irrigating. d. Occlude the ear canal completely with the syringe while irrigating.
As a healthcare professional, how would you explain to a diabetic patient the outcome of discontinuing thyroid treatment without notifying the physician?
A. Stopping thyroid therapy may bring about hypoglycemia unless the antidiabetic medication is readjusted. B. Stopping thyroid therapy may bring about exophthalmos. C. Stopping thyroid therapy may bring about hyperglycemia unless the antidiabetic medication is readjusted. D. None of these are correct.
The student nurse asks the nursing instructor why he needs to take anatomy and physiology, as well as microbiology, when he only wants to learn about pharmacology. What is the best response by the instructor?
1. "Because pharmacology is an outgrowth of those subjects." 2. "You must learn all, since those subjects, as well as pharmacology, are part of the curriculum." 3. "Knowledge of all those subjects will prepare you to provide the best patient care, including the administration of medications." 4. "Because an understanding of those subjects is essential to understanding pharmacology."