On Day 2 at 16:00, the client is kept NPO.
An exploratory laparotomy is scheduled for tomorrow at 06:00. Metoclopramide 10 mg IV every 6 hours and Cefazolin 2g IV on call for surgery are ordered.
Which of the following actions should the nurse assist with?

Discontinue the nasogastric tube.

Provide the client with ice chips.

Start the prescribed antibiotic.

Reinforce preoperative teaching.

Answer and Explanation

The Correct Answer is C

Choice A rationale

Discontinuing the nasogastric tube is not the best action to take at this time. The nasogastric tube may be necessary for decompression of the stomach or administration of medications and should not be removed without a specific order from the healthcare provider.

Choice B rationale

Providing the client with ice chips is not the most appropriate action. The client is kept NPO (nothing by mouth) before surgery to prevent aspiration during anesthesia. Therefore, giving the client ice chips could increase the risk of aspiration.

Choice C rationale

Starting the prescribed antibiotic is the correct action. Cefazolin is an antibiotic that is often given before surgery to prevent postoperative infections. Administering this medication as ordered can help to ensure that the client is adequately prepared for surgery.

Choice D rationale

While reinforcing preoperative teaching is an important part of nursing care, it is not the most immediate action that should be taken in this situation. The client’s physical preparation for surgery, including the administration of prescribed medications, should be prioritized.

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Correct Answer is C

Explanation

Choice A rationale

Accepting that sexual activity will decrease does not necessarily indicate acceptance of a new altered body image. It may reflect a misunderstanding or fear about the impact of the colostomy.

Choice B rationale

Denying feelings of sadness about the ostomy does not necessarily indicate acceptance of a new altered body image. It may suggest that the patient is not fully acknowledging the emotional impact of the change.

Choice C rationale

Participating in performing ostomy care is a positive sign that the patient has accepted their new altered body image. It shows that the patient is taking an active role in their care and adapting to the change.

Choice D rationale

Preferring not to look at the stoma site does not indicate acceptance of a new altered body image. It may suggest avoidance or denial.

A. Consume the medication in its entirety. B. Keep the medication in a cool place. C. Accompany the medication with grapefruit juice. D. Administer the medication during meals.

Correct Answer is A

Explanation

Choice A rationale

Diltiazem is a calcium channel blocker used to treat high blood pressure and prevent chest pain (angina). It works by relaxing the blood vessels so the heart does not have to pump as hard. It also increases the supply of blood and oxygen to the heart. The sustained-release tablets are designed to release the medication slowly in the body. Therefore, patients are advised to consume the medication in its entirety. Crushing, chewing, or breaking the tablet would cause too much of the drug to be released at one time.

Choice B rationale

While it’s generally a good idea to store medications in a cool, dry place, specific storage instructions for diltiazem sustained-release tablets are not typically emphasized. The focus is more on the method of consumption.

Choice C rationale

Grapefruit and grapefruit juice may interact with diltiazem and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor. Therefore, it’s not advisable to accompany the medication with grapefruit juice.

Choice D rationale

Diltiazem can be taken with or without food. If it upsets the patient’s stomach, it can be taken with food. However, it’s not a mandatory instruction that the medication must be administered during meals.

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On Day 2 at 16:00, the client is kept NPO.An exploratory laparotomy is scheduled for tomorrow at 06:00. Metoclopramide 10 mg IV every 6 hours and Cefazolin 2g IV on call for surgery are ordered.Which of the following actions should the nurse assist with?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is collecting data from a patient who has a newly placed colostomy.Which of the following findings would indicate to the nurse that the patient has accepted their new altered body image?

Correct Answer is C

Explanation

A nurse is providing instructions to a patient who has been prescribed diltiazem sustained-release tablets for hypertension.Which of the following instructions should the nurse include?

Correct Answer is A

Explanation

A client is about to wear a Holter monitor for the next 24 hours. What advice should the nurse provide?

A nurse is assisting with postoperative care of a patient who had surgery for creation of a colostomy 24 hours ago. Which findings should the nurse report to the provider?

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On Day 2 at 16:00, the client is kept NPO.
An exploratory laparotomy is scheduled for tomorrow at 06:00. Metoclopramide 10 mg IV every 6 hours and Cefazolin 2g IV on call for surgery are ordered.
Which of the following actions should the nurse assist with?