A nurse is caring for a client who is 3 hr postoperative following abdominal surgery.
Which of the following assessment data should the nurse report to the provider?
Serosanguineous drainage noted on the abdominal dressing.
Postoperative laboratory results are Hgb 15% and Hct 40%.
The client's urine output has been 50 mL since surgery.
The client's pain level has decreased since the administration of morphine.
The Correct Answer is C
Choice A rationale:
Serosanguineous drainage noted on the abdominal dressing is a common finding in the early postoperative period. It is a mixture of clear and bloody drainage and is often seen after surgery. This does not typically require immediate reporting unless it becomes excessive or changes significantly. The nurse can continue to monitor and assess the situation.
Choice B rationale:
Postoperative laboratory results of Hgb 15% and Hct 40% are within the normal range for most adults, and there is no immediate need to report these results to the provider. These values suggest that the client's hemoglobin and hematocrit levels are within an acceptable range, indicating adequate oxygen-carrying capacity.
Choice C rationale:
The client's urine output has been 50 mL since surgery, which is significantly decreased and could indicate a potential issue with renal function or fluid balance. This should be reported to the provider, as it may be indicative of kidney impairment, dehydration, or other postoperative complications.
Choice D rationale:
The client's pain level decreasing after the administration of morphine is an expected response to pain management interventions. There is no need to report this information to the provider unless the pain relief is inadequate or the client experiences adverse effects. Pain management is an essential part of postoperative care, and successful pain reduction is a positive outcome.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
The correct answer is Choice D: Obtaining a blood pressure for a client who is to be discharged later in the day.
Choice A rationale:
Providing tracheostomy care requires specialized training and assessment skills, which are beyond the scope of practice for assistive personnel (AP).
Choice B rationale:
Assessing a client who just returned from surgery involves clinical judgment and decision-making, which are responsibilities of a licensed nurse, not assistive personnel.
Choice C rationale:
Teaching a client how to use an incentive spirometer requires patient education skills and the ability to assess the client's understanding, which are tasks for a licensed nurse.
Choice D rationale:
Obtaining a blood pressure is a routine task that can be delegated to assistive personnel, as it does not require advanced clinical judgment or specialized training.
Correct Answer is A
Explanation
The correct answer is Choice A: Coordinates all healthcare client has received into one platform.
Choice A rationale:
Electronic health records (EHRs) integrate all of a patient's healthcare information into one centralized platform, making it easier for healthcare providers to access and coordinate care.
Choice B rationale:
While EHRs can allow for sharing information with authorized individuals, granting significant other access to client information is not a primary function of EHRs and requires specific consent and permissions.
Choice C rationale:
EHRs do provide information that can be used for research studies, but this is not a primary benefit emphasized in patient education.
Choice D rationale:
EHRs do allow clients to access their medical records electronically, but this is not the primary focus of the teaching about the benefits of EHRs.
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