After receiving report, the nurse can most safely plan to assess which client last?

An adult client with a tracheal tube draining clear, pale red liquid drainage

An older client with dark red drainage on a postoperative dressing, but no drainage in the Hemovac.

An adult client with no postoperative drainage in the Jackson-Pratt drain with the bulb compressed.

An older client with a distended abdomen and no drainage from the nasogastric tube.

Answer and Explanation

The Correct Answer is C

Choice A: An adult client with a tracheal tube draining clear, pale red liquid drainage. This client should not be assessed last, as they may have a potential airway obstruction or infection. The tracheal tube drainage should be monitored for color, amount, and consistency, and suctioned as needed.

Choice B: An older client with dark red drainage on a postoperative dressing, but no drainage in the Hemovac. This client should not be assessed last, as they may have a potential hemorrhage or wound dehiscence. The postoperative dressing and Hemovac should be monitored for color, amount, and odor, and changed as needed.

Choice C: An adult client with no postoperative drainage in the Jackson-Pratt drain with the bulb compressed. This client can be assessed last, as they have no signs of complications or problems. The Jackson-Pratt drain is a closed suction device that collects fluid from a surgical site. The bulb should be compressed to create negative pressure and facilitate drainage.

Choice D: An older client with a distended abdomen and no drainage from the nasogastric tube. This client should not be assessed last, as they may have a potential bowel obstruction or perforation. The nasogastric tube is inserted through the nose into the stomach to decompress gas and fluid. The abdomen should be monitored for size, shape, and bowel sounds, and the nasogastric tube should be checked for patency and placement.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is ["31.6"]

Explanation

The correct answer is : 31.6 mL

Let’s calculate this step by step:

Step 1: Convert 10 mg of teriparatide to mcg. We know that 1 mg = 1000 mcg. So, 10 mg = 10 × 1000 mcg = 10000 mcg.

Step 2: The medication is labeled as 760 mcg/2.4 ml. This means that 760 mcg of the medication is present in 2.4 mL.

Step 3: Now, we need to find out how many ml will contain 10000 mcg of the medication. We can set up a proportion to solve this:

(760 mcg / 2.4 ml) = (10000 mcg / x mL)

Step 4: Solving for x, we cross-multiply and divide:

x ml = (10000 mcg × 2.4 ml) ÷ 760 mcg

Step 5: Calculate the result:

x ml = 24000 mcg·ml ÷ 760 mcg = 31.57894736842105 mL

Step 6: If rounding is required, round to the nearest tenth:

x ml = 31.6 mL

So, the nurse should administer 31.6 mLof the medication.

A. Keep the bed in the lowest position and initiate seizure and fall precautions. B. Place an indwelling urinary catheter and measure strict intake and output. C. Maintain elevated positioning of the dependent joints on affected side. D. Start two large bore IV catheters and review inclusion criteria for IV fibrinolytic therapy.

Correct Answer is D

Explanation

Choice A reason: Keeping the bed in the lowest position and initiating seizure and fall precautions is not an immediate action for the nurse to take. Seizure and fall precautions are measures that prevent injury or harm to the client in case of a seizure or a fall. Seizure and fall precautions include lowering the bed, padding the side rails, removing any objects that may cause injury, and having suction and oxygen equipment ready. However, these precautions are not specific to the client's condition and do not address the underlying cause.

Choice B reason: Placing an indwelling urinary catheter and measuring strict intake and output is not an urgent action for the nurse to take. An indwelling urinary catheter is a tube that drains urine from the bladder into a collection bag. Measuring intake and output is a way of monitoring fluid balance and kidney function. However, these interventions are not essential for the client's condition and may increase the risk of infection or trauma.

Choice C reason: Maintaining elevated positioning of the dependent joints on affected side is not a relevant action for the nurse to take. Dependent joints are joints that are below the level of the heart, such as the ankles or wrists. Elevating dependent joints can help reduce swelling or pain by improving blood flow and drainage. However, this intervention is not related to the client's condition and does not improve neurological function.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

After receiving report, the nurse can most safely plan to assess which client last?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is preparing a dose of 10 mg of teriparatide. The medication is labeled 760 mcg/2.4 mL. How many mL should the nurse administer? (Enter numeric value only. If rounding is required, round to the nearest tenth.)

Correct Answer is ["31.6"]

Explanation

The nurse is caring for a client who arrives to the emergency department with reports of experiencing dizziness and difficulty walking to the bathroom.The nurse observes right-sided weakness and sluggish enunciation of speech. The nurse should immediately take which action?

Correct Answer is D

Explanation

A client is being discharged with a prescription for warfarin. Which instruction should the nurse provide this client regarding diet?

The nurse is preparing a 50 mL dose of 50% Dextrose IV for a client with insulin shock. How should the nurse administer the medication?

The nurse is educating a client about essential hypertension prevention. Which information should the nurse provide? (Select all that apply.)

The psychiatric nurse is caring for clients on an adolescent unit. Which client requires the nurse’s immediate attention?

Which laboratory results should the nurse closely monitor in a client who has end-stage renal disease (ESRD.?