A nurse is preparing to provide care to a client who is postoperative following an abdominal hysterectomy 24 hr ago. Which of the following scheduled tasks should the nurse perform first?
Discontinue the client's PCA.
Measure the client's vital signs.
Remove the client's indwelling urinary catheter.
Change the client's abdominal dressing
The Correct Answer is B
A. Discontinue the client's PCA:
The discontinuation of the patient-controlled analgesia (PCA) may be necessary, but assessing the client's vital signs is a priority to ensure the client's overall stability and response to the surgery.
B. Measure the client's vital signs:
This is the correct answer. Assessing vital signs is a priority postoperatively to monitor the client's physiological status, detect any signs of complications, and guide further interventions.
C. Remove the client's indwelling urinary catheter:
Removing the urinary catheter may be part of the postoperative care plan, but it is not the immediate priority. Vital sign assessment is crucial for overall patient monitoring.
D. Change the client's abdominal dressing:
Changing the abdominal dressing is an important aspect of postoperative care, but assessing vital signs takes precedence to identify any signs of distress or instability.
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Related Questions
Correct Answer is C
Explanation
A. "A client can obtain a copy of their psychotherapy notes":
This statement is incorrect. Psychotherapy notes are generally not accessible to clients without specific authorization.
B. "I can remain logged-on to my computer if I step away for less than 5 minutes":
This statement is incorrect. It is essential to log off from the computer when stepping away to protect the confidentiality of client information.
C. "I will ensure that my screen isn't visible to others when I'm documenting":
This is the correct answer. Ensuring that the computer screen is not visible to others is an important practice to maintain confidentiality. It prevents unauthorized individuals from accessing sensitive client information.
D. "I will create a simple password that is easy to remember":
This statement is not recommended. Passwords should be strong and secure to protect against unauthorized access. Using a simple and easily guessable password compromises the confidentiality of electronic health records.
Correct Answer is ["38"]
Explanation
To calculate the IV flow rate in drops per minute (gtt/min), you can use the following formula:
Flow Rate (gtt/min)=(Volume (mL)/Time (min)) × Drop Factor (gtt/mL)
In this case:
Flow Rate = (150 mL/hr / 60 min/hr) × 15 gtt/mL
Flow Rate=37.5gtt/min
Therefore, the nurse should set the IV flow rate to deliver approximately 38 gtt/min for the dextrose 5% in water IV infusion at 150 mL/hr, rounded to the nearest whole number.
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