A nurse is monitoring a client who is 36 hrs postoperative following gastric banding. Which of the following findings should the nurse expect?

The client is voiding at least 250 mL/hr.

The client is maintaining bed rest.

The client is tolerating clear liquids.

The client is consuming 1.000 calories daily.

Answer and Explanation

The Correct Answer is C

A. The client is voiding at least 250 mL/hr. This amount is excessive and not typical. The expected urine output for an adult is at least 30 mL/hr, so 250 mL/hr could indicate overhydration or diuretic use, which is not expected postoperatively.
B. The client is maintaining bed rest. Early ambulation is encouraged after surgery to prevent complications like deep vein thrombosis and promote recovery. Bed rest 36 hours post-op is not expected unless medically indicated.
C. The client is tolerating clear liquids. After gastric banding, clients typically start with clear liquids and gradually progress to more solid foods. Tolerating clear liquids at 36 hours post-op is an expected and positive finding.
D. The client is consuming 1,000 calories daily. At this stage post-op, calorie intake is significantly restricted, often much lower than 1,000 calories. Intake gradually increases as the diet progresses from liquids to solids.

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Correct Answer is ["A","B","C","E","F"]

Explanation

A. Heart rate. The client’s heart rate decreased from 110/min on postpartum day 3 to 78/min on day 5, returning to normal resting range, which suggests improvement in systemic inflammation or infection, and better overall hemodynamic stability.
B. Temperature. The temperature has decreased from 38.6° C (101.5° F) to 37.1° C (98.9° F), which is within normal limits. This reduction is a key indicator of resolving infection or inflammation, especially considering the earlier febrile response.
C. Lochia. Lochia has improved from a moderate, foul-smelling, dark brown discharge to a small amount of brownish-red lochia with no odor, which suggests infection resolution and appropriate progression of postpartum uterine involution.
D. Hgb. The client’s hemoglobin dropped from 11.1 g/dL to 10 g/dL, which is below the normal postpartum range. This is likely due to ongoing recovery, recent surgery, and fluid shifts, but it does not indicate improvement and may require continued monitoring.
E. WBC count. The WBC count normalized from a significantly elevated 33,000/mm³ to 10,000/mm³, which is within the normal reference range. This is a strong sign that the infection or inflammatory response is resolving.
F. Fundal height. The fundus has decreased from 1 cm above the umbilicus on day 3 to 4 cm below on day 5, which is consistent with normal involution of the uterus during the postpartum period and is a positive sign of recovery.

A. Aspirin 1 tablet daily B. Furosemide 20 mg BID C. Nitroglycerin transdermal patch D. Metoprolol 5 mg now

Correct Answer is B

Explanation

A. Aspirin 1 tablet daily. This prescription is incomplete because it does not specify the dose in milligrams. Aspirin comes in multiple strengths, and clarity is essential to ensure safe administration.
B. Furosemide 20 mg BID. This prescription is complete because it includes the medication name, dosage (20 mg), and frequency (twice daily). It provides all necessary components for safe administration.
C. Nitroglycerin transdermal patch. This order lacks critical details such as the dosage, frequency, and duration of use. Without this information, the prescription is incomplete and cannot be safely implemented.
D. Metoprolol 5 mg now. Although it includes the medication, dosage, and timing, it does not specify the route (e.g., oral, IV), which is necessary for the prescription to be considered complete.

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A nurse is monitoring a client who is 36 hrs postoperative following gastric banding. Which of the following findings should the nurse expect?

Nursing Test Bank

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