A nurse is caring for a client who is restrained to each extremity. Which of the following assessments should the nurse perform first?

Elimination needs

Comfort level

Skin integrity

Peripheral pulses.

Answer and Explanation

The Correct Answer is D

When a client is restrained to each extremity, it is important for the nurse to assess the client’s peripheral pulses first to ensure that circulation is not compromised.

Choice A, Elimination needs, is important but not the first priority in this situation.

Choice B, Comfort level, is also important but not the first priority in this situation.

Choice C, Skin integrity, is important but not the first priority in this situation.

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Correct Answer is A

Explanation

After postoperative surgery, chances of infections are very high also discharges, color changes, etc.
So it is important to expose the client’s abdomen to look for changes in appearance.

Choice B is not the answer because determining areas of resonance across the abdomen using a systematic approach is not the first action that should be taken 1.
Choice C is not the answer because using the diaphragm of a stethoscope to listen for bowel sounds is not the first action that should be taken 1.
Choice D is not the answer because performing abdominal palpation by pressing gently with the finger pads is not the first action that should be taken 1.

A. Remove the needle from the syringe. B. Recap the needle before disposal. C. Discard the needle in a puncture-proof container. D. Place the needle on the bedside table.

Correct Answer is C

Explanation

After administering an injection, a nurse should discard the needle in a puncture-proof container.
This is a recommended practice to ensure the safety of injections and related practices.
Choice A is wrong because removing the needle from the syringe is not necessary.
Choice B is wrong because recapping the needle before disposal is not recommended as it increases the risk of needlestick injuries.
Choice D is wrong because placing the needle on the bedside table poses a risk of injury and infection.

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A nurse is caring for a client who is restrained to each extremity. Which of the following assessments should the nurse perform first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is 2 days postoperative following bowel resection and reports sudden, severe abdominal pain. Which of the following actions should the nurse take first?

Correct Answer is A

Explanation

A nurse is preparing to administer an injection to a client. Which of the following actions should the nurse plan to take after administering the injection?

Correct Answer is C

Explanation

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