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A nurse is caring for a client.

Click on the findings that require immediate follow-up. To deselect a finding, click on the finding again.

Nurses' Notes

1500:

Client is alert and oriented to person, place, and time. Client is 4 hr postoperative following abdominal surgery. Surgical site has a small amount of serosanguineous drainage on dressing. Dressing is intact. Client reports pain as 5 on a scale of 0 to 10. Lung sounds are diminished in posterior lobes. Bowel sounds are hypoactive in all 4 quadrants. Last bowel movement was this morning.

1730:

Client is restless and short of breath. Reports pain as 8 on a scale of 0 to 10. Pain medication administered.

Vital Signs

1730:

Temperature 37.2° C (98.9° F)

Blood pressure 168/84 mm Hg

Heart rate 116/min

Respiratory rate 24/min

Oxygen saturation 93% on room air

a small amount of serosanguineous drainage

Lung sounds are diminished in posterior lobes

pain as 5 on a scale of 0 to 10

Blood pressure 168/84 mm Hg

Respiratory rate 24/min

Oxygen saturation 93% on room air

Bowel sounds are hypoactive in all 4 quadrants

Answer and Explanation

The Correct Answer is ["A","B","C","D"]

a small amount of serosanguineous drainage,

Lung sounds are diminished in posterior lobes,

pain as 8 on a scale of 0 to 10,

Blood pressure 168/84 mm Hg

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

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Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is ["A","B","E"]

Explanation

Choice A reason:

Checking medication expiration dates is important to ensure that medications are safe and effective.

Choice B reason:

Having a fire escape plan is crucial in case of emergencies such as fires. It's important for the client and their family to know how to evacuate the home safely.

Choice C reason:

Setting the hot water heater to 140 degrees Fahrenheit is too hot and can lead to scalding. The recommended temperature is typically around 120 degrees Fahrenheit to prevent burns.

Choice D reason:

Applying tape to frayed electrical cords is not a safe practice. Frayed cords should be replaced to avoid electrical hazards.

Choice E reason:

Using grab bars when getting in and out of the bathtub can prevent slips and falls, especially in a potentially slippery environment.

A. Place the tourniquet above the proposed insertion site. B. Place the extremity in a dependent position. C. Choose the most proximal site on the extremity selected. D. Apply a cool compress for several minutes before insertion of the IV catheter.

Correct Answer is A

Explanation

Choice A reason:
A. Place the tourniquet below the proposed insertion site.
When preparing to insert an IV catheter, placing the tourniquet below the proposed insertion site helps facilitate venous distension, making it easier to locate and access a suitable vein for catheter insertion.
Choice B reason:
Placing the extremity in a dependent position (lower than the heart) can increase venous pressure and make it more difficult to insert the catheter.
Choice C reason:
Choosing the most proximal site on the extremity is not always necessary or appropriate. Veins distal to the proposed insertion site should be considered first, as they tend to be smaller and less accessible.
Choice D reason:
Applying a cool compress is not typically done before IV catheter insertion. It might cause vasoconstriction and make it more difficult to access a suitable vein.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A home health nurse is teaching a client about home safety. Which of the following statements by the client indicates an understanding of the teaching? (Select all that apply.)

Correct Answer is ["A","B","E"]

Explanation

A nurse is preparing to insert an IV catheter for an adult client. Which of the following actions should the nurse take?

Correct Answer is A

Explanation

A nurse is preparing to administer a controlled substance to a client for pain management. Which of the following actions should the nurse take?

A nurse is preparing to administer a controlled substance to a client for pain management. Which of the following actions should the nurse take?

A nurse is planning care for a female client who has an indwelling urinary catheter. Which of the following actions should the nurse include in the plan?

A nurse is planning care for a client who has a latex allergy and is scheduled for surgery. Which of the following actions is appropriate to include in the client's plan of care?

A nurse is caring for a client who has a prescription for a 250 mL IV fluid bolus. The nurse administers a 500 mL IV bolus. Which of the following actions should the nurse take first?

A nurse is assessing the skin of a client who has worked outdoors for the past 20 years. Which of the following findings is the nurse's priority?

A nurse is preparing to administer gentamicin 2 mg/kg IV to a client who weighs 220 lb. How many mg should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)