A nurse is contributing to the plan of care for an adolescent client following surgery for a ruptured appendix. Which of the following interventions should the nurse recommend to include in the plan?
Encourage the client to change positions every 4 hr.
Offer the client a clear liquid diet when fully alert.
Ensure that the client receives pain medication prior to ambulation.
Discontinue antibiotic therapy on the first postoperative day.
The Correct Answer is C
A. Encourage position change every 4 hr
Should be more frequent, typically every 2 hr to prevent complications.
B. Offer clear liquids when fully alert
Bowel sounds and flatus should be confirmed first to avoid ileus.
C. Ensure the client receives pain medication prior to ambulation.
Adequate pain control promotes mobility and reduces complications like atelectasis.
D. Discontinue antibiotics on first post-op day
Antibiotics are continued as per provider order, especially with ruptured appendix.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. 1⁄2 cup long grain rice
Low in calcium (~2 mg per ½ cup).
B. 1 medium avocado
Low in calcium (~20 mg per avocado).
C. 2 tbsp peanut butter
Contains some calcium (~17 mg) but much less than dairy.
D. 1 cup frozen yogurt
Frozen yogurt contains significant calcium (~200–300 mg per cup).
Correct Answer is C
Explanation
A. Place large pillows under the knees when lying in bed:
This can promote joint contractures and misalignment.
B. Sleep on a soft mattress:
Soft mattresses provide poor support and may worsen joint pain.
C. Apply moist heat to the knees:
Moist heat promotes muscle relaxation, reduces stiffness, and improves circulation in affected joints.
D. Use a recliner when sitting for long periods:
Prolonged sitting can stiffen joints. Clients should be encouraged to change positions frequently.
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