Which patient finding indicates the need for further monitoring rather than discharge home after an outpatient surgical procedure?
Inability to void without fluid retention
Persistent nausea without vomiting
Lethargy that resolves after several hour
Pain management with opioid analgesics
The Correct Answer is A
A. Inability to void without fluid retention. Urinary retention is a common post-op complication, especially after anesthesia, and requires monitoring to prevent bladder distension or kidney issues.
B. Persistent nausea without vomiting. Nausea can be managed with antiemetics and does not necessarily require prolonged monitoring.
C. Lethargy that resolves after several hours. Post-anesthesia drowsiness is expected and does not necessarily indicate a need for extended observation.
D. Pain management with opioid analgesics. Pain control with opioids is expected and does not, by itself, require extended monitoring.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Chest physiotherapy (CPT) every 4 hours while awake. CPT is used to mobilize secretions but may be too aggressive for a patient with infiltrates and respiratory distress, as it can increase fatigue and worsen respiratory status.
B. Oxygen therapy via nasal cannula at 3 to 4 L/min. Low-flow oxygen therapy is often used in COPD to prevent hypoxemia while avoiding CO₂ retention.
C. Add humidification to the oxygen source. Humidified oxygen helps prevent airway dryness and improves secretion clearance, which is beneficial for COPD patients.
D. Raise the head of the patient's bed. Elevating the head of the bed promotes lung expansion and improves oxygenation, making this an appropriate intervention.
Correct Answer is B
Explanation
A. HCO3 above 26 mEq/L: This would indicate metabolic alkalosis, not metabolic acidosis.
B. pH below 7.35: Metabolic acidosis is characterized by a low pH (<7.35) due to excess acid accumulation or bicarbonate loss.
C. PaCO2 above 45 mm Hg: PaCO2 above 45 mm Hg is seen in respiratory acidosis, not metabolic acidosis.
D. PaO2 below 70 mm Hg: A low PaO2 indicates hypoxemia, which can occur alongside acidosis but is not a defining feature of metabolic acidosis.
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