A nurse is caring for a client who is postoperative following an endoscopy with moderate (conscious) sedation.

Which of the following assessment findings is the nurse's priority?

Level of pain.

Gag reflex.

Warmth of extremities.

Temperature.

Answer and Explanation

The Correct Answer is B

The nurse’s priority should be to assess the client’s gag reflex.

After an endoscopy with moderate (conscious) sedation, it is important to ensure that the client’s gag reflex has returned before allowing them to eat or drink.
Choice A is incorrect because while pain management is important, it is not the nurse’s priority in this situation.
Choice C is incorrect because the warmth of extremities is not the nurse’s priority in this situation.
Choice D is incorrect because temperature is not the nurse’s priority in this situation.

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Correct Answer is C

Explanation

“Weight loss of.8 kg (4 Ib) in the past 24 hr.” Furosemide is a diuretic that decreases the pressure caused by excess fluid in the heart and lungs.
A weight loss of.8 kg (4 Ib) in the past 24 hr indicates that excess fluid is being removed from the body, which is a sign that the medication is effective.
Choice A is incorrect because adventitious breath sounds are a symptom of pulmonary edema, not an indication that the medication is effective.
Choice B is incorrect because furosemide has direct vasodilatory outcomes 2, which would decrease blood pressure, not elevate it.
Choice D is incorrect because there is no information found to support this statement.

A. Respiratory acidosis. B. Metabolic alkalosis. C. Respiratory alkalosis. D. Metabolic acidosis.

Correct Answer is D

Explanation

The client’s ABG results show a pH of 7.24, which is below the normal range of 7.35-7.45 and indicates acidosis.
The PaCO2 is within the normal range of 35-45 mm Hg, indicating that the acidosis is not caused by a respiratory issue.
The HCO3 level is 18 mEq/L, which is below the normal range of 22-28 mEq/L and indicates a primary metabolic cause for acidosis.
Respiratory acidosis is not indicated by the ABG results as the PaCO2 is within the normal range.
B) Metabolic alkalosis is not indicated by the ABG results as the pH and HCO3 levels are below their respective normal ranges.
C) Respiratory alkalosis is not indicated by the ABG results as the pH is below the normal range and the PaCO2 is within the normal range.

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A nurse is caring for a client who is postoperative following an endoscopy with moderate (conscious) sedation. Which of the following assessment findings is the nurse's priority?

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Naxlex Comprehensive Predictor Exams

A nurse is administering furosemide 80 mg PO twice daily to a client who has pulmonary edema. Which of the following assessment findings indicates to the nurse that the medication is effective?

Correct Answer is C

Explanation

A nurse is caring for a client who has chronic renal failure. The client displays the following ABG results: pH 7.24, PaCO2 44 mm Hg, PaO2 84 mm Hg. HCO3 18 mEq/L, base excess -2, and O2 saturation 95%. The nurse should conclude that the client has which of the following acid-base imbalances?

Correct Answer is D

Explanation

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A nurse is caring for a client who is postoperative following an endoscopy with moderate (conscious) sedation.

Which of the following assessment findings is the nurse's priority?