Following a bowel resection, a client's tympanic temperature was 97.6° F (36.4° C) on admission to the postanesthesia care unit (PACU). Thirty minutes later, the temperature is 101.6°F (38.7° C). Which intervention(s) should the nurse implement? Select all that apply.

Expose client's extremities and apply ice packs to axilla.

Recheck all vital signs including core temperature.

Continue to monitor vital signs every hour.

Apply oxygen via nasal prongs at 4 L/minute.

Page the admitting anesthesiologist STAT

Answer and Explanation

Correct Answer : B,D,E

A. Ice packs can be used but are not the first priority.
B. Rechecking core temperature confirms the severity of hyperthermia.
C. Monitoring hourly is insufficient for a rapidly rising temperature.
D. Oxygen helps prevent hypoxia from hypermetabolic states.
E. Malignant hyperthermia is a medical emergency requiring immediate intervention.

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Correct Answer is ["A","C","D","E","G"]

Explanation

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.

Correct Answer is ["12.5"]

Explanation

1. Determine the total daily dose:

Total daily dose = 1.5 grams

2. Determine the single dose:

Since the medication is to be administered every 8 hours (three times a day), divide the total daily dose by 3:

Single dose = 1.5 grams / 3 doses = 0.5 grams

3. Convert grams to milligrams:

0.5 grams = 500 mg

4. Calculate the volume to administer:

The concentration of the medication is 200 mg/5 mL.

To find the volume, divide the desired dose (500 mg) by the concentration (200 mg/5 mL):

Volume = 500 mg / (200 mg/5 mL) = 12.5 mL

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Following a bowel resection, a client's tympanic temperature was 97.6° F (36.4° C) on admission to the postanesthesia care unit (PACU). Thirty minutes later, the temperature is 101.6°F (38.7° C). Which intervention(s) should the nurse implement? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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.

Correct Answer is ["A","C","D","E","G"]

Explanation

Correct Answer is ["12.5"]

Explanation

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