A nurse is caring for a client who is postoperative and requesting something to drink. The nurse reads the client's postoperative prescriptions, which include, "Clear liquids, advance diet as tolerated." Which of the following actions should the nurse take first?

Order a lunch tray for the client.

Offer the client apple juice.

Auscultate the client's abdomen.

Elevate the client's head of bed.

Answer and Explanation

The Correct Answer is C

A. Order a lunch tray for the client. Before advancing the diet, it is important to assess the client's readiness, particularly bowel sounds.
B. Offer the client apple juice. Providing liquids is appropriate only after assessing the client's gastrointestinal function.
C. Auscultate the client's abdomen: This assessment checks for the return of bowel sounds and gastrointestinal function, indicating whether the client can tolerate clear liquids.
D. Elevate the client's head of bed. While positioning is important, the primary first step is to assess the client's gastrointestinal status

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Correct Answer is B

Explanation

A. Hold the medication until the client has his evening meal: Holding the medication for this reason is inappropriate because the issue is the elevated potassium level, not the timing with meals.
B. Inform the provider of the client's potassium level: Correct. A potassium level of 5.8 mEq/L is elevated (hyperkalemia), and the provider should be informed immediately before administering any more potassium.
C. Obtain a prescription to increase the dosage of the medication: Increasing the dosage would be dangerous given the elevated potassium level.
D. Give the medication as prescribed: Administering potassium chloride with a high potassium level is unsafe and could exacerbate the hyperkalemia.

A. 45 B. 75° C. 90° D. 60°

Correct Answer is C

Explanation

A. 45°: This angle is typically used for subcutaneous injections, not intramuscular injections.
B. 75°: This angle is not standard for any type of injection.
C. 90°: Correct. Intramuscular injections should be administered at a 90-degree angle to ensure the medication reaches the muscle tissue.
D. 60°: This angle is not standard for intramuscular injections.

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A nurse is caring for a client who is postoperative and requesting something to drink. The nurse reads the client's postoperative prescriptions, which include, "Clear liquids, advance diet as tolerated." Which of the following actions should the nurse take first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to administer potassium chloride to a client who has a potassium level of 5.8 mEq/L. Which of the following actions should the nurse take?

Correct Answer is B

Explanation

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Correct Answer is C

Explanation

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