Exhibits
The nurse is preparing the client for surgery. Which of the following actions should the nurse take? Select all that apply
Obtain a complete blood count.
Prepare client for insertion of 18-gauge peripheral IV prior to surgery.
Administer Rh, D immune globulin prior to surgery.
Explain the surgical procedure to the client.
Verify consent form is signed by the client.
Assist with administration of AB positive blood products if needed.
Remind client to be NPO prior to surgery.
Correct Answer : A,B,C,E,G
Based on the given information, the nurse should take the following actions in preparation for surgery:
- Obtain a complete blood count: This is important to assess the client's hemoglobin, hematocrit, and other blood parameters before surgery.
 - Prepare the client for insertion of an 18-gauge peripheral IV prior to surgery: Adequate IV access is necessary for the administration of fluids and medications during and after surgery.
 - Administer Rh, D immune globulin prior to surgery: This action is indicated if the client is Rh-negative and there is a possibility of fetal-maternal blood mixing during the termination of pregnancy. Rh, D immune globulin is given to prevent sensitization to Rh-positive blood.
 - Verify consent form is signed by the client: Ensuring that the client has provided informed consent is essential before proceeding with any surgical intervention.
 - Remind the client to be NPO (nothing by mouth) prior to surgery: It is important for the client to have an empty stomach to reduce the risk of aspiration during anesthesia.
 
The following actions are not indicated based on the given information:
- Explaining the surgical procedure to the client: Although it is important for the client to have an understanding of the procedure, this is typically done by the surgeon rather than the nurse.
 - Assisting with administration of AB positive blood products if needed: There is no indication of the need for blood products based on the information provided. Blood product administration would be determined based on the client's specific condition and surgical requirements.
 
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Gentamicin is an aminoglycoside antibiotic that is known to have potential ototoxicity, which means it can cause damage to the inner ear and result in hearing loss. It is important for the nurse to monitor the client's hearing during gentamicin therapy and report any changes or symptoms of hearing loss promptly. Other adverse effects of gentamicin may include nephrotoxicity (kidney damage), so monitoring renal function is also essential.
Hypotension, constipation, and slurred speech are not typically associated with gentamicin use. However, it is important for the nurse to monitor the client for any adverse effects and report any concerning symptoms to the healthcare provider.
Correct Answer is C
Explanation
Explanation
C.I should check my heart rate while taking the medication
Timolol is a medication commonly prescribed for the treatment of primary open-angle glaucoma, which is a chronic eye condition characterized by increased intraocular pressure
hacking the heart rate while taking timolol eye drops is important. Timolol belongs to a class of medications called beta-blockers, which can have systemic effects. These medications can enter the bloodstream and potentially affect heart rate and blood pressure. Monitoring the heart rate can help assess for any potential adverse effects of the medication.
Taking a zinc supplement in (option A) is not correct because it is not typically necessary while taking timolol eye drops. Zinc supplementation is not a direct requirement or related to the use of timolol for glaucoma treatment. The client should follow their healthcare provider's instructions regarding medication use and potential dietary modifications, but zinc supplementation is not specifically associated with timolol.
Timolol eye drops in (option B) is not correct because it does not darken the colour of the eyes. The purpose of timolol eye drops is to reduce intraocular pressure by decreasing the production of fluid in the eye. Eye colour changes are not known effects of timolol eye drops.
Timolol eye drops in (option D) is incorrect because it does not dilate the eyes. In fact, they work by reducing intraocular pressure, not by dilating the eyes. Eye dilation is typically achieved with the use of specific eye drops called mydriatics or with the use of specialized ophthalmic instruments during an eye examination.
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