A nurse is caring for an older adult client in the PACU following general anesthesia. Which of the following findings should the nurse report to the provider?

Urine output 120 mL in 4 hr

Systolic blood pressure 12 mm Hg lower than the preoperative level

Audible stridor

Normal sinus rhythm with an occasional premature ventricular contraction

Answer and Explanation

The Correct Answer is C

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Correct Answer is D

Explanation

A. Speaking loudly in a high-pitched voice is not effective for individuals with sensorineural hearing loss, as they may struggle with high-frequency sounds.

B. Asking the client's partner to choose their meal removes the client's autonomy and does not facilitate direct communication.

C. While expecting extended time for verbal responses is considerate, it does not provide a practical solution for meal selection.

D. Asking the client to point to items on a picture menu is an effective way to facilitate communication, allowing the client to express their preferences without relying on verbal communication alone.

A. Restrict visits from young children to 2 hr per day. B. Avoid including raw fruits in the client's diet. C. Measure the client's temperature every 8 hr. D. Use disposable gloves from a box outside the client's room.

Correct Answer is B

Explanation

A. While restricting visits from young children may help reduce infection risk, it is not a sufficient or specific intervention for neutropenic precautions.

B. Avoiding raw fruits is critical because they can harbor bacteria and increase the risk of infection in neutropenic clients. Cooked fruits are safer options.

C. Measuring temperature should occur more frequently than every 8 hours, ideally every 4 hours or more, to quickly identify fever, a sign of infection.

D. Disposable gloves should be used from within the client's room to maintain strict infection control measures; using gloves from outside could introduce contaminants.

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A nurse is caring for an older adult client in the PACU following general anesthesia. Which of the following findings should the nurse report to the provider?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Explanation

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