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Exam NCLEX-RN topic 7 question 99 discussion

Actual exam question from Test Prep's NCLEX-RN
Question #: 99
Topic #: 7
[All NCLEX-RN Questions]

A client had a cardiac catheterization with angiography and thrombolytic therapy with streptokinase. The nurse should initiate which of the following interventions immediately after he returns to his room?

  • A. Place him on NPO restriction for 4 hours.
  • B. Monitor the catheterization site every 15 minutes.
  • C. Place him in a high Fowler position.
  • D. Ambulate him to the bathroom to void. B
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Suggested Answer: Explanation 🗳️
(A) A contrast dye, iodine, is used in this procedure. This dye is nephrotoxic. The client must be encouraged to drink plenty of liquids to assist the kidneys in eliminating the dye. (B) Streptokinase activates plasminogen, dissolving fibrin deposits. To prevent bleeding, pressure is applied at the insertion site. The client is assessed for both internal and external bleeding. (C) The extremity used for the insertion site must be kept straight and be immobilized because of the potential for bleeding. (D) The client is kept on bed rest for 812 hours following the procedure because of the potential for bleeding.

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