A nurse is preparing a client for surgery and has just administered the preoperative injection.
Which of the following actions should the nurse take?

Take the client to the bathroom to void.

Ask the client to verify the surgical site.

Review deep breathing and coughing exercises.

Raise the side rails on the bed.

Answer and Explanation

The Correct Answer is D

A. Taking the client to the bathroom after administering a preoperative sedative increases the risk of falls.
B. Surgical site verification should be completed before administering the preoperative medication.
C. Teaching should be done before giving the medication, as the sedative may impair learning and recall.
D. Raising the side rails helps ensure client safety by preventing falls after the medication has been administered.

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Correct Answer is C

Explanation

A. A child who has a forehead wound that is bleeding copiously: While bleeding wounds require attention, they are not immediately life-threatening compared to other injuries described.

B. A child who has a compound fracture of the femur and is crying in pain: While painful, a

femur fracture is not typically immediately life-threatening unless it is causing severe bleeding or compromising circulation.

C. A child who reports diplopia and nausea and was unconscious at the scene but is now awake:

These symptoms suggest potential head trauma and require urgent evaluation to assess for intracranial injuries.

D. A child who has several missing permanent teeth and a swollen, ecchymotic upper lip: These injuries, while concerning, are not immediately life-threatening compared to the potential head injury described in option C.

A. Speak directly into one of the client's ears. B. Rephrase sentences the client does not understand. C. Drop voice volume at the end of sentences. D. Exaggerate lip movements.

Correct Answer is B

Explanation

A. Speaking directly into one of the client's ears may not effectively improve communication for someone with a hearing impairment, especially if the impairment is bilateral.

B. Rephrasing sentences the client does not understand can help improve comprehension by providing information in a different way.

C. Dropping voice volume at the end of sentences may make it difficult for the client to hear the end of the sentence, especially if they have a hearing impairment.

D. Exaggerating lip movements may not be helpful and can actually make lip-reading more difficult for some individuals.

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A nurse is preparing a client for surgery and has just administered the preoperative injection. Which of the following actions should the nurse take?

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A nurse is preparing a client for surgery and has just administered the preoperative injection.
Which of the following actions should the nurse take?