A patient with suspected appendicitis is being prepared for surgery. Which of the following preoperative interventions should the nurse prioritize?
Apply a heating pad to the abdomen
Administer a cleansing enema
Administer oral analgesics as needed
Place the patient on NPO status
The Correct Answer is D
A. Apply a heating pad to the abdomen: This is incorrect and potentially harmful, as applying heat to the abdomen can increase blood flow and worsen inflammation or risk rupture of the appendix.
B. Administer a cleansing enema: Enemas should not be administered for suspected appendicitis as they may cause irritation and increase the risk of perforation.
C. Administer oral analgesics as needed: Oral analgesics are contraindicated since the patient should be NPO, and strong pain relief might mask the symptoms of a ruptured appendix.
D. Place the patient on NPO status: The highest priority preoperative intervention is to place the patient on NPO (nothing by mouth) status to prevent aspiration during anesthesia, a standard preoperative practice, especially for abdominal surgeries.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Flush the T-tube with sterile water every 6 hours to maintain patency: T-tubes are generally not flushed unless prescribed by a healthcare provider because flushing can introduce bacteria and cause complications. Patency is typically maintained by gravity drainage alone.
B. Clamp the T-tube for 12 hours each day to reduce bile flow: Clamping the T-tube is not routinely recommended for such long periods unless directed by the healthcare provider. Clamping is usually done gradually, often for 1-2 hours, to assess the patient’s ability to tolerate bile drainage naturally before tube removal.
C. Secure the T-tube to the patient's gown to prevent accidental dislodgement: While securing the T-tube prevents accidental dislodgement, the tube should be taped to the skin rather than the gown, as attaching it to clothing can increase the risk of unintentional dislodgement with movement.
D. Maintain the drainage bag below the level of the abdomen to promote gravity drainage. This is the correct answer because positioning the drainage bag below the abdomen allows for gravity to assist in the flow of bile from the bile duct, preventing backup and promoting proper drainage.
Correct Answer is D
Explanation
A. The patients have lowered their cholesterol levels from previous laboratory results: Lower cholesterol levels are a positive health outcome but could result from factors other than weight loss, such as medication or diet changes. It is a good sign but not the most direct measure of the intervention's success.
B. The patients have improved blood pressure readings to be within expected reference range: Blood pressure improvements are important and can result from weight loss, but other factors like medications could influence this outcome.
C. The patients are choosing healthier food options for their diet plans: While choosing healthier food options is a positive behavior change, it is a process measure rather than an outcome. It does not necessarily indicate the interventions are working as effectively as a decrease in BMI.
D. There is a significant decrease in the patients' BMI measurements. A significant reduction in BMI is the most direct indicator of effective weight-loss interventions. A decrease in BMI reflects a measurable outcome that directly relates to weight loss.
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