A PACU nurse is monitoring the drainage from a client's NG tube following abdominal surgery. Which of the following findings in the first postoperative hour should the nurse report to the provider?

75 mL of greenish-yellow drainage

150 mL of serosanguineous drainage

100 mL of red drainage

200 mL of brown drainage

Answer and Explanation

The Correct Answer is C

Choice A reason:

75 mL of greenish-yellow drainage should not be reported. This could be stomach contents or bile, which can be expected after surgery and might not be alarming.

Choice B reason:

150 mL of serosanguineous drainage should not be reported. Serosanguineous drainage is a mix of clear and slightly bloody fluid, which can be expected after surgery and may not be alarming.

Choice C reason:

100 mL of red drainage should be reported. After abdominal surgery, the drainage from an NG (nasogastric) tube is monitored to assess the client's condition and the status of their gastrointestinal system. Red drainage could indicate bleeding, which is a significant concern after surgery. The nurse should report this finding to the provider for further evaluation and intervention.

Choice D reason:

200 mL of brown drainage should not be reported. Brown drainage could also be indicative of old blood or digestive fluids, which might be expected after surgery and may not be alarming.

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Correct Answer is A

Explanation

Choice A Reason:

"I should use salt sparingly while cooking. “Response A indicates the client's understanding of the dietary teaching. Using salt sparingly while cooking is consistent with a low-sodium diet. It shows that the client recognizes the importance of reducing sodium intake to adhere to the prescribed dietary restrictions.

Choice B Reason:

"I can use baking soda when I bake" - Baking soda contains sodium and is not typically recommended for someone on a low-sodium diet.

Choice C Reason:

"I should use canned instead of frozen vegetables" - Canned vegetables often contain added sodium for preservation, so choosing fresh or frozen vegetables without added salt is a better option for a low-sodium diet.

Choice D Reason:

"I can season my foods with lemon juice" - Lemon juice is a suitable alternative to adding sodium for flavour, and this statement shows the client's understanding of using low-sodium seasoning options.

A. "Describe your daily medication schedule." B. “Tell me why it's important to have your CD4+ count checked." C. "List some ways you can cope with the stress of your illness." D. “Name a few things you will change about your diet."

Correct Answer is B

Explanation

Choice A Reason:

"Describe your daily medication schedule” is not the correct statement. Understanding the medication schedule is important for adherence to antiretroviral therapy.

Choice B Reason:

"Tell me why it's important to have your CD4+ count checked." Is the correct statement, the priority information for the nurse to review with the client is why it's important to have their CD4+ count checked regularly? The CD4+ count is a crucial marker of immune system health and function in individuals with HIV. Monitoring CD4+ counts help guides treatment decisions, assess the effectiveness of antiretroviral therapy, and evaluate the progression of the disease. Understanding the significance of CD4+ counts is essential for the client's overall management of HIV.

Choice C Reason:

"List some ways you can cope with the stress of your illness" is not the correct statement - Coping strategies are important for the client's emotional well-being and overall health.

Choice D Reason:

"Name a few things you will change about your diet" is not the correct statement. Nutrition is important for overall health, including maintaining a strong immune system, but it may not be the most immediate priority compared to understanding the importance of CD4+ counts.

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A PACU nurse is monitoring the drainage from a client's NG tube following abdominal surgery. Which of the following findings in the first postoperative hour should the nurse report to the provider?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing dietary teaching to a client who has heart failure and a new prescription for a 2-g sodium diet. Which of the following client statements should the nurse identify as an understanding of the teaching?

Correct Answer is A

Explanation

A nurse is providing discharge teaching for a client who has HIV. Which of the following information is the priority for the nurse to review with the client?

Correct Answer is B

Explanation

A nurse is providing discharge teaching to a client who has heart failure and instructs him to limit sodium intake to 2 g per day. Which of the following statements by the client indicates an understanding of the teaching?

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