Which actions by the nurse are examples of dependent nursing interventions for a postoperative patient? (Select all that apply).

Calculating the patient’s fluid intake and output at the end of every shift.

Assessing the patient’s abdomen for distention, bowel sounds, and passage of flatus.

Administering a mild stool softener daily to prevent constipation.

Encouraging fluid and fiber intake to prevent constipation from pain medications.

Reinserting the patient's urinary catheter for retention of greater than 500 mL of urine.

Answer and Explanation

Correct Answer : C

Choice A reason: This is an incorrect choice because calculating the patient’s fluid intake and output at the end of every shift is an example of an independent nursing intervention. An independent nursing intervention is an action that the nurse can perform based on their own knowledge, skills, and judgment without a physician's order. The nurse can monitor the patient’s fluid balance and document the results.

Choice B reason: This is an incorrect choice because assessing the patient’s abdomen for distention, bowel sounds, and passage of flatus is an example of an independent nursing intervention. An independent nursing intervention is an action that the nurse can perform based on their own knowledge, skills, and judgment without a physician's order. The nurse can perform a physical examination of the patient’s abdomen and document the findings.

Choice C reason: This is a correct choice because administering a mild stool softener daily to prevent constipation is an example of a dependent nursing intervention. A dependent nursing intervention is an action that the nurse can perform only with a physician's order. The nurse cannot give any medication to the patient without a prescription.

Choice D reason: This is an incorrect choice because encouraging fluid and fiber intake to prevent constipation from pain medications is an example of an independent nursing intervention. An independent nursing intervention is an action that the nurse can perform based on their own knowledge, skills, and judgment without a physician's order. The nurse can educate the patient about the importance of hydration and nutrition and document the teaching.

Choice E reason: This is a correct choice because reinserting the patient's urinary catheter for retention of greater than 500 mL of urine is an example of a dependent nursing intervention. A dependent nursing intervention is an action that the nurse can perform only with a physician's order. The nurse cannot insert or remove any invasive device from the patient without a prescription.

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Correct Answer is C

Explanation

Choice A reason: This is an incorrect choice because using empathy is not the correct term for the nursing action of deciding that a nonverbal patient who just had surgery is in pain and administering an analgesic, based on the observation that the patient moans with position changes, the hands are clenched, and the skin is very sweaty. Empathy is a communication technique that involves understanding and sharing the feelings of another person. However, it is not the term that describes the cognitive process of drawing conclusions from the available data.

Choice B reason: This is an incorrect choice because setting priorities is not the correct term for the nursing action of deciding that a nonverbal patient who just had surgery is in pain and administering an analgesic, based on the observation that the patient moans with position changes, the hands are clenched, and the skin is very sweaty. Setting priorities is a nursing skill that involves determining the order of importance of the patient's problems and interventions. However, it is not the term that describes the cognitive process of drawing conclusions from the available data.

Choice C reason: This is the correct choice because making inferences is the correct term for the nursing action of deciding that a nonverbal patient who just had surgery is in pain and administering an analgesic, based on the observation that the patient moans with position changes, the hands are clenched, and the skin is very sweaty. Making inferences is a critical thinking skill that involves reaching a logical judgment or assumption based on the available data and evidence. The nurse makes an inference that the patient is in pain based on the patient's nonverbal cues and the fact that the patient just had surgery.

Choice D reason: This is an incorrect choice because recognizing inconsistencies is not the correct term for the nursing action of deciding that a nonverbal patient who just had surgery is in pain and administering an analgesic, based on the observation that the patient moans with position changes, the hands are clenched, and the skin is very sweaty. Recognizing inconsistencies is a critical thinking skill that involves identifying discrepancies or contradictions in the data or information. However, it is not the term that describes the cognitive process of drawing conclusions from the available data.

A. Professional shared governance B. Nursing care delivery model C. Interprofessional communication D. Continuing staff education

Correct Answer is C

Explanation

Choice A reason: This is an incorrect choice because professional shared governance is not a patient care action, but an organizational model that empowers nurses and other health care professionals to participate in decision making and policy development within their practice settings.

Choice B reason: This is an incorrect choice because nursing care delivery model is not a patient care action, but a framework that defines how nursing care is organized, coordinated, and delivered to the patients. Examples of nursing care delivery models include primary nursing, team nursing, and case management.

Choice C reason: This is the correct choice because interprofessional communication is a patient care action that involves exchanging information, ideas, and feedback among health care professionals from different disciplines who work together to provide comprehensive care for the patients. Interprofessional communication enhances collaboration, quality, and safety of care.

Choice D reason: This is an incorrect choice because continuing staff education is not a patient care action, but a professional development activity that involves updating and enhancing the knowledge and skills of the health care staff through formal or informal learning opportunities. Continuing staff education improves the competence and performance of the staff.

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Which actions by the nurse are examples of dependent nursing interventions for a postoperative patient? (Select all that apply).

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

What is the correct term for the nursing action of deciding that a nonverbal patient who just had surgery is in pain and administering an analgesic, based on the observation that the patient moans with position changes, the hands are clenched, and the skin is very sweaty?

Correct Answer is C

Explanation

Once a week, staff members from all the disciplines caring for the trauma patients get together to discuss their progress. Which term best describes this patient care action?

Correct Answer is C

Explanation

Which patient’s needs must be addressed first by the registered nurse?

Which assessment finding leads the nurse to add risk for poisoning to the patient’s care plan?

Why is acute pain particularly dangerous for a patient having a heart attack?

Which bath time assessment of the diabetic patient is most important?

A patient’s spouse smokes cigarettes in the kitchen while the patient uses supplemental oxygen in the bedroom. Which is the priority nursing diagnosis for this family?

The nurse is caring for a patient who has been unable to have a bowel movement for the last 4 days after taking prescribed narcotic pain medication. Which nursing diagnosis is appropriate for this patient?

A small amount of mercury was spilled on the floor after an old sphygmomanometer was broken. What is the priority action of the nurse?

Which instruction will the nurse give to the patient about proper use of patient-controlled analgesia (PCA)?