A nurse is caring for a client who is postoperative.
Which of the following should the nurse request as a recommendation in an SBAR report to the provider? Select All That Apply
Medication for elevated temperature
Insertion of NG tube for decompression
Oxygen 2 to 4 L/min via nasal cannula
Insertion of urinary catheter
Evaluation of surgical wound drain
Correct Answer : A,E
A. While the client's temperature is not extremely high, it is elevated and persistent. Requesting an antipyretic or further evaluation may be warranted to prevent potential complications.
B. Insertion of NG tube for decompression is not necessary as the client is passing flatus and has bowel sounds in all quadrants, indicating normal gastrointestinal function.
C. Oxygen 2 to 4 L/min via nasal cannula is not necessary since the client's SpO2 levels are within normal range on room air.
D. The client's urinary output is adequate (400 mL over 6 hours), so a catheter is not required at this time.
E. The lack of drainage from the wound drain could indicate a problem that requires immediate attention. This could prevent complications like infection or fluid accumulation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Rationale:
A. Discovery phase is when depositions are typically taken, as this phase involves gathering evidence and information from parties involved.
B. Decision phase occurs after the trial to determine the verdict.
C. Trial phase involves presenting evidence and arguments, but depositions occur earlier during discovery.
D. Complaint phase involves filing the lawsuit and does not include depositions.
Correct Answer is A
Explanation
Rationale:
A. The physiologic status of the clients is the most critical factor in assigning tasks, ensuring that clients with more complex needs receive appropriate care.
B. Social relationships are secondary to patient safety and quality of care.
C. Personal comfort level should not influence assignment decisions; patient care needs are the priority.
D. Assigning the most experienced nurse to complex clients is appropriate, but it should be based on client needs rather than just experience alone.
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