A nurse is caring for an adolescent who is postoperative following epidural anesthesia. Which of the following findings should the nurse expect?
Hypertension
Mild sedation
Urinary retention
Respiratory depression
The Correct Answer is C
A. "Hypertension" Epidural anesthesia typically causes hypotension, not hypertension, due to vasodilation and decreased sympathetic nervous system activity.
B. "Mild sedation" While some systemic absorption of anesthetics may occur, epidural anesthesia primarily affects sensory and motor function rather than causing significant sedation.
C. "Urinary retention" Epidural anesthesia can inhibit bladder sensation and detrusor muscle function, leading to urinary retention. The nurse should monitor urine output and assess for bladder distention.
D. "Respiratory depression" While respiratory depression can occur with high doses of opioids administered through an epidural, it is not a common expected effect of epidural anesthesia alone.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D","F","H"]
Explanation
A. Neurologic assessment. Neurologic changes can indicate worsening infection, sepsis, or other serious conditions, requiring immediate follow-up.
B. Hemoglobin. The child's hemoglobin level (9.5 g/dL) is below the normal range (10 to 15.5 g/dL), indicating anemia, which requires monitoring and possible intervention.
C. Peripheral pulses. There is no indication of circulatory compromise or perfusion issues in the given data.
D. WBC. The elevated WBC count (14,000 mm³) suggests an active infection or inflammation, which requires immediate follow-up.
E. Glucose. The glucose level (90 mg/dL) is within normal limits and does not require immediate attention.
F. Abdominal assessment. If the child has an infection, especially a serious bacterial infection, monitoring for abdominal distension, tenderness, or signs of peritonitis is crucial.
G. Pain assessment. While pain assessment is always important, it does not require immediate follow-up unless there are specific pain-related concerns in the provided data.
H. Temperature. Fever is a key sign of infection. Monitoring the child’s temperature is crucial in identifying worsening infection or sepsis.
Correct Answer is B
Explanation
A. "I will seal nonwashable items in a plastic bag for 1 week." Nonwashable items (e.g., stuffed animals, pillows) should be sealed in a plastic bag for at least 2 weeks, not just 1 week, to ensure all lice and nits die.
B. "I will place hairbrushes, combs, and hair accessories in boiling water for 10 minutes." Boiling these items in water for at least 5–10 minutes effectively kills lice and nits.
C. "I will wash my child's clothing and bedding using a double rinse." Clothing and bedding should be washed in hot water (at least 130°F or 54°C) and dried on high heat, but a double rinse is not necessary.
D. "I will use the medicated shampoo on my child's hair daily for 3 days." Medicated lice shampoos should be used once, followed by a repeat application in 7–10 days if needed. Daily use is not recommended due to potential toxicity and irritation.
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