Exam 5 Ch9

21問 • 3年前

問題一覧

1. A preoperative nurse is assessing a client prior to surgery. Which information would be most important for the nurse to relay to the surgical team?

d. Use of multiple herbs and supplements

2. A nurse works on the postoperative floor and has four clients who are being discharged tomorrow. Which one has the greatest need for the nurse to consult other members of the health care team for postdischarge care?

c. Older adult who lives alone at home despite some memory loss.

3. A clinic nurse is teaching a client prior to surgery. The client does not seem to comprehend the teaching, forgets a lot of what is said, and asks the same questions again and again. What action by the nurse is best?

a. Assess the client for anxiety.

4. A preoperative nurse is reviewing morning laboratory values on four clients waiting for surgery. Which result warrants immediate communication with the surgical team?

c. Potassium: 2.9 mEq/L (2.9 mmol/L)

5. An inpatient nurse brings an informed consent form to a client for an operation scheduled for tomorrow. The client asks about possible complications from the operation. What response by the nurse is best?

b. Do not have the client sign the consent and call the primary health care provider.

6. A client has a great deal of pain when coughing and deep breathing after abdominal surgery despite having pain medication. What action by the nurse is best?

b. Demonstrate how to splint the incision.

7. A nurse is giving a client instructions for showering the night before surgery. What instruction is most appropriate?

b. “Use the prescribed solution and wash the area where you will have surgery very thoroughly.”

8. A postoperative client has an abdominal drain. What assessment by the nurse indicates that goals for the priority client problems related to the drain are being met?

b. There is no redness, warmth, or drainage at the insertion site.

9. The perioperative nurse manager and the postoperative unit manager are concerned about the increasing number of surgical infections in their hospital. What action by the managers is best?

a. Audit charts to see if the Surgical Care Improvement Project (SCIP) outcomes were met.

10. A nurse assesses a client in the preoperative holding area and finds brittle nails and hair, dry skin turgor, and muscle wasting. What action by the nurse is best?

a. Consult the primary health care provider about a dietitian referral.

11. A client has arrived in the inpatient postoperative unit. What action by the inpatient nurse takes priority?

d. Participating in hand-off report

12. The postanesthesia care unit (PACU) charge nurse notes vital signs on four postoperative clients. Which client would the nurse assess first?

c. Client with a respiratory rate of 6 breaths/min

13. A client had a surgical procedure with spinal anesthesia. The client’s blood pressure was 122/78 mm Hg 30 minutes ago and is now 138/60 and the client reports nausea. What action by the nurse is best?

c. Notify the primary health care provider.

14. A postoperative client vomited. After cleaning and comforting the client, which action by the nurse is most important?

b. Auscultate lung sounds.

15. A postoperative client has just been admitted to the postanesthesia care unit (PACU). What assessment by the PACU nurse takes priority?

a. Airway

16. A postoperative client has respiratory depression after receiving morphine for pain. Which medication and dose does the nurse prepare to administer?

c. Naloxone 0.4 to 2 mg

17. A nurse on the postsurgical inpatient unit is observing a client perform leg exercises. What action by the client indicates a need for further instruction?

b. Bends both knees, pushes against the bed until calf and thigh muscles contract.

18. A registered nurse (RN) is watching a new nurse change a dressing and perform care around a Penrose drain. What action by the new nurse warrants intervention?

c. Securing the drain’s safety pin to the sheets

19. A postoperative nurse is caring for a client who received a neuromuscular blocking agent during surgery. On assessment the nurse notes the client has weak hand grasps. What assessment does the nurse conduct next?

c. Signs of oxygenation

20. The postanesthesia care unit (PACU) nurse is caring for an older client following a lengthy surgery. The client’s pulse is 48 beats/min which is 20 beats/min lower than the preoperative baseline. What assessment does the nurse make next?

a. Temperature

21. The postoperative nurse is caring for a client who reports feeling “something popped” after vomiting. What action by the nurse is best?

d. Gather sterile nonadherent dressings.

NUR 170 exam 4

V Farris · 50問 · 2年前

NUR 170 exam 4