A nurse is caring for a client who is postoperative and requesting something to drink. The nurse reads the client's postoperative prescriptions, which include, "Clear liquids, advance diet as tolerated." Which of the following actions should the nurse take first?
Order a lunch tray for the client.
Offer the client apple juice.
Auscultate the client's abdomen.
Elevate the client's head of bed.
The Correct Answer is C
A. Order a lunch tray for the client. Before advancing the diet, it is important to assess the client's readiness, particularly bowel sounds.
B. Offer the client apple juice. Providing liquids is appropriate only after assessing the client's gastrointestinal function.
C. Auscultate the client's abdomen: This assessment checks for the return of bowel sounds and gastrointestinal function, indicating whether the client can tolerate clear liquids.
D. Elevate the client's head of bed. While positioning is important, the primary first step is to assess the client's gastrointestinal status
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Perform hand hygiene with an alcohol-based agent: Alcohol-based hand sanitizers are not effective against C. difficile spores. Soap and water should be used.
B. Obtain stool cultures from all clients on the nursing unit: Only clients with symptoms should have stool cultures obtained.
C. Request the providers to initiate antibiotic therapy for every client on the unit: Antibiotic therapy should only be started after a confirmed diagnosis, as unnecessary antibiotics can contribute to antibiotic resistance.
D. Place all clients who have manifestations on contact precautions: This helps prevent the spread of C. difficile until lab results confirm the diagnosis.
Correct Answer is B
Explanation
A. Prone: The prone position is not conducive for administering a rectal suppository.
B. Sim's: Sim's position (lying on the left side with the right knee bent) allows for easier access to the rectum and promotes comfort during administration.
C. Dorsal recumbent: This position is not ideal for rectal suppository administration.
D. Fowler's: Fowler's position is used for feeding and respiratory treatments, not for administering rectal medications.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.