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Exhibits

The nurse is caring for the client the morning after her surgery.

Click to select the 5 most important nursing interventions for postoperative client care.

Encourage sitting up and ambulation

Monitor for bleeding once daily

Use Incentive spirometer every 1 hour

Promote adequate hydration

Assess for sedation after pain medications

Complete neurologic assessment every 2 hours

Administer pain medication after activity

Answer and Explanation

Correct Answer : A,C,D,E,G

A. Early ambulation helps prevent complications such as atelectasis, pneumonia, and deep vein thrombosis (DVT). It also promotes intestinal motility.
B. Monitoring for bleeding should be more frequent, especially in the immediate postoperative period, rather than just once daily.
C. This helps prevent respiratory complications such as atelectasis and promotes lung expansion.
D. Adequate hydration is essential to maintain fluid balance, promote healing, and prevent complications such as urinary tract infections and constipation.
E. Monitoring for sedation is crucial to ensure that pain medications are not causing excessive drowsiness, which could impair the client's ability to participate in activities such as ambulation and use of the incentive spirometer.
F. While assessing neurological status is important, frequent neurological assessments are more relevant for clients with neurological conditions or concerns. In this case, routine assessments should be sufficient unless the client has specific neurological symptoms.
G. Administering pain medication after activity helps manage pain more effectively and encourages the client to engage in necessary postoperative activities.

Nursing Test Bank

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Naxlex Comprehensive Predictor Exams

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Free Nursing Study Resources

Correct Answer is B

Explanation

A. Carrots are a good source of vitamin A, but they do not provide sufficient calcium or vitamin D for bone health.

B. Low-fat yogurt is an excellent source of calcium and vitamin D, which are important for postmenopausal women at risk for osteoporosis due to hormonal changes.

C. Beets are nutritious but are not particularly relevant for improving bone health.

D. Mixed berries are a great source of antioxidants but do not provide the same bone-strengthening nutrients as low-fat yogurt.

A. Mononucleosis. B. Toxic shock syndrome. C. Herpes simplex virus. D. Syphilis

Correct Answer is D

Explanation

A. Mononucleosis typically presents with fever, sore throat, and lymphadenopathy, but it is not associated with a rash on the palms and soles.

B. Toxic shock syndrome typically involves fever, hypotension, and multi-organ failure, with a rash that involves the palms and soles, but it is often linked to tampon use or wound infections.

C. Herpes simplex virus does not typically cause this type of rash and would not present with a sore throat and fever in this pattern.

D. The presence of fever, sore throat, and a rash on the hands, palms, and soles of the feet is characteristic of secondary syphilis, which can occur a few weeks to months after the initial infection.

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Exhibits The nurse is caring for the client the morning after her surgery. Click to select the 5 most important nursing interventions for postoperative client care.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is providing a nutrition class to a group of postmenopausal clients. Which food should the nurse emphasize to this group?

Correct Answer is B

Explanation

A female client presents to the clinic with a fever and sore throat as well as a rash on the hands, palms, and the soles of the feet. The client reports having intercourse once with a new partner approximately 8 weeks ago. Which condition should the nurse suspect?

Correct Answer is D

Explanation

Exhibits Complete the diagram by dragging from the choices area to specify which condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client's progress.

A client with deep vein thrombosis (DVT) is receiving a continuous heparin IV infusion. The client now has tarry, black diarrhea and reports abdominal pain. Which actions should the nurse implement? Select all that apply.

Exhibits The nurse is caring for the client the morning after her surgery. Click to select the 5 most important nursing interventions for postoperative client care.

A client newly diagnosed with diabetes mellitus suddenly becomes confused and weak. Which intervention(s) should the nurse implement? Select all that apply.

The nurse is working on an infectious disease unit. Which client should be assigned to a room with negative airflow, while requiring personnel to use a particulate respirator mask, and requiring staff to observe airborne, as well as standard precautions?

A client with heart failure (HF) develops cardiac tamponade. The client has muffled, distant heart sounds, and is anxious and restless. After initiating oxygen therapy and IV hydration, which intervention is most important for the nurse to implement?

Exhibits

The nurse is caring for the client the morning after her surgery.

Click to select the 5 most important nursing interventions for postoperative client care.