A nurse is assessing a client who is 6 hours postoperative following a total abdominal hysterectomy. Which of the following findings should the nurse report to the provider?
The client has decreased bowel sounds in all four quadrants.
The client’s total urinary output is 75 mL in the last 3 hours.
The client reports a pain level of 4 on a scale of 0 to 10.
The client’s dressing has a scant amount of dark red drainage.
None
None
The Correct Answer is B
Choice A reason: Decreased bowel sounds 6 hours post-hysterectomy are expected due to anesthesia and surgical manipulation, typically resolving within 24-48 hours. Urinary output of 75 mL in 3 hours is more urgent. Assuming bowel sounds require reporting risks overlooking critical renal issues, potentially delaying intervention in postoperative care.
Choice B reason: Urinary output of 75 mL in 3 hours (25 mL/hour) is below the expected 30-50 mL/hour, indicating potential renal compromise or obstruction post-hysterectomy, requiring immediate reporting. This ensures timely intervention, critical for preventing acute kidney injury, ensuring fluid balance, and supporting recovery in postoperative clients.
Choice C reason: A pain level of 4 is moderate and manageable with routine analgesics, not requiring immediate provider reporting compared to low urinary output. Assuming pain is urgent risks misprioritizing, potentially delaying critical interventions for renal issues, essential for ensuring comprehensive postoperative care and client stability.
Choice D reason: Scant dark red drainage is expected 6 hours post-hysterectomy, indicating minor surgical oozing, not requiring immediate reporting. Low urinary output is priority. Assuming drainage is concerning risks diverting focus from renal complications, critical for preventing kidney injury and ensuring safe recovery in postoperative clients.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Having children at home is relevant for social support but less critical for occupational therapy than home layout, like a two-story home. Assuming children are priority risks overlooking functional adaptations, critical to avoid in ensuring tailored rehabilitation for clients post-amputation.
Choice B reason: Penicillin allergy is medical information, not directly relevant to occupational therapy, which focuses on functional adaptations for a two-story home. Assuming allergy is key risks diverting focus from rehabilitation needs, critical to prevent in supporting recovery post-amputation in occupational therapy planning.
Choice C reason: Reporting a two-story home is critical, as it impacts occupational therapy planning for mobility and daily tasks post-amputation, ensuring adaptations like stair aids. This is essential for functional independence, safety, and rehabilitation, supporting effective recovery and quality of life in clients with arm amputations.
Choice D reason: A parent in a nursing facility is unrelated to occupational therapy needs, unlike a two-story home, which affects mobility. Assuming this is relevant risks neglecting home adaptation needs, critical to avoid in ensuring functional rehabilitation and independence for clients post-amputation.
Correct Answer is A
Explanation
Choice A reason: Checking IV pump cords for fraying ensures electrical safety, preventing shocks or malfunctions, critical for client and staff safety. This routine inspection is essential for equipment reliability, supporting safe infusion delivery, and adhering to hospital safety protocols in managing IV therapy for clients.
Choice B reason: Removing the safety inspection sticker is inappropriate; it verifies equipment safety. Checking cords is correct. Assuming sticker removal is needed risks using unverified equipment, potentially causing malfunctions, critical to avoid in ensuring safe IV pump operation for client infusions.
Choice C reason: Grasping the cord to unplug risks damage or shock; the plug should be held. Checking cords is priority. Assuming cord grasping is safe risks electrical hazards, critical to prevent in ensuring safe handling and operation of IV pumps in client care settings.
Choice D reason: Two-prong outlets are outdated; medical equipment requires three-prong grounded outlets. Checking cords is key. Assuming two-prong outlets are safe risks electrical hazards, critical to avoid in ensuring proper IV pump function and safety for clients receiving infusions in healthcare settings.
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