A nurse is caring for a client who is postoperative following an open cholecystectomy. Which of the following assessment findings should the nurse report to the provider?
Report of shoulder pain
Thick, green-brown drainage on dressing
Incisional pain 5 out of 10 on a pain scale
Abdominal dressing dry and intact
The Correct Answer is B
This finding could indicate the presence of bile leakage, which can occur following a cholecystectomy. The provider should be notified immediately as the client may require further interventions. Incisional pain, shoulder pain, and a dry and intact abdominal dressing are expected findings in the postoperative period.
Choice A, reporting of shoulder pain, is not the correct answer because this is a common finding post-cholecystectomy, which is often due to the presence of carbon dioxide used during the surgical procedure.
Choice C, incisional pain 5 out of 10 on a pain scale, is not the correct answer because this level of pain is within the expected range for the postoperative period.
Choice D, abdominal dressing dry and intact, is not the correct answer because this is an expected finding in the postoperative period.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["1000"]
Explanation
To calculate the number of calories the client should reduce their daily intake by to lose 0.9 kg (2 lb) of body fat per week , we can use the following formula: (0.9 kg/week) x (1 lb/0.45 kg) x (3500 calories/1 lb) = 7,000 calories/week To find the daily calorie reduction, divide 7,000 by 7 days: 7,000 calories/7 days = 1,000 calories/day Therefore, the nurse should instruct the client to reduce their daily caloric intake by 1,000 calories. Answer: 1000
Correct Answer is A
Explanation
The correct answer is choice A, participate in reminiscence therapy with the client. This is an effective intervention for individuals with Alzheimer's disease. It involves encouraging the client to discuss past experiences and events. It has been shown to improve mood, decrease agitation, and increase communication skills. The reminiscence therapy should be individualized and tailored to the client's interests and abilities.
- Raising the four side rails on the client's bed is not the correct answer because this could cause harm to the client by restricting their mobility and independence.
- Alternating the client's daily routine is not the correct answer because individuals with Alzheimer's disease benefit from a consistent routine, which helps them to feel more secure and less anxious.
- Keeping the lights dimmed is not the correct answer because it can be disorienting and confusing for clients with Alzheimer's disease, who need adequate lighting to distinguish their surroundings.
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