A nurse is preparing a client for a hip arthroplasty. For which of the following reasons should the nurse assess the client's vital signs?

To determine how the client will tolerate the procedure

To establish a baseline for postoperative assessment

To prevent postoperative hypotension

To assess the client's pain level

Answer and Explanation

The Correct Answer is B

A.   Vital signs, including blood pressure, heart rate, respiratory rate, and temperature, provide baseline information about the client's cardiovascular and respiratory status. This assessment helps predict how well the client might tolerate the surgical procedure under anesthesia and monitor for any deviations during the procedure.
B.   Establishing baseline vital signs before surgery provides a comparison point for monitoring the client's recovery and identifying any postoperative complications. Changes in vital signs postoperatively can indicate potential issues such as bleeding, fluid imbalance, or respiratory compromise.
C.   Monitoring blood pressure before surgery helps identify clients at risk for intraoperative hypotension, particularly important during induction of anesthesia and throughout the surgical procedure. Establishing baseline blood pressure levels guides intraoperative management to maintain hemodynamic stability.
D.   While vital signs are important for assessing physiological status, they do not directly assess pain. Pain assessment involves asking the client about their pain experience, location, intensity, and factors that alleviate or exacerbate pain. Vital signs can indirectly reflect pain if pain causes changes in heart rate or blood pressure, but they are not specific indicators of pain.

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Free Nursing Study Resources

Correct Answer is ["300"]

Explanation

To calculate the volume of IV fluids infused from 0330 to 0600, you would determine the number of hours that have passed.

From 0330 to 0600 is 2.5 hours. Since the IV is infusing at 120 mL/hr, you would multiply the infusion rate by the number of hours. So, 120 mL/hr * 2.5 hours = 300 mL.

Therefore, the nurse should record 300 mL of IV fluids on the intake record at 0600.

A. Assessment B. Planning C. Implementation D. Evaluation

Correct Answer is A

Explanation

A. Assessment is the first phase of the nursing process where the nurse collects data about the client's health status, including medical history, current symptoms, and potential allergies. During the assessment phase, the nurse should specifically ask the client about any known allergies to medications, foods, or other substances. This information is crucial for ensuring patient safety during diagnostic testing and any subsequent treatments.
B. The planning phase involves developing a care plan based on the assessment data gathered. While the nurse does consider potential allergies during this phase when planning interventions and care strategies, the primary focus is on creating a plan that addresses the client's specific needs and goals.
C. Implementation is the phase where the nurse carries out the interventions outlined in the care plan. If the client has allergies identified during the assessment phase, the nurse must ensure that these allergies are communicated to the healthcare team and that appropriate precautions are taken during diagnostic testing and any procedures or treatments.

D. Evaluation is the final phase of the nursing process where the nurse assesses the client's response to interventions and determines the effectiveness of the care plan. Although allergies are primarily addressed in the assessment phase, the nurse continues to monitor for allergic reactions throughout the client's care and promptly addresses any concerns that arise.

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A nurse is preparing a client for a hip arthroplasty. For which of the following reasons should the nurse assess the client's vital signs?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who had IV fluids initiated at 0330. The IV fluids are infusing at 120 mL/hr. The nurse should record how many mL of IV fluids on the intake record at 0600?

Correct Answer is ["300"]

Explanation

A nurse in a clinic is interviewing a client who will undergo diagnostic testing. The nurse should ask about a client's potential allergies during which phase of the nursing process?

Correct Answer is A

Explanation

A nurse is reviewing the medical records of four clients who have an acid-base imbalance. The nurse should recognize that which of the following clients is at risk for metabolic acidosis?

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A nurse is preparing a client for a hip arthroplasty. For which of the following reasons should the nurse assess the client's vital signs?

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