A nurse is receiving postoperative report for a school-age child following surgery for a ruptured appendix. Which of the following prescriptions should the nurse expect?

Place the client in a supine position for the first 12 hr postoperative.

Pack the open wound with a dry gauze dressing.

Administer naproxen orally for pain 30 min prior to ambulation.

Maintain an NG tube on low intermittent suction until bowel sounds return.

Answer and Explanation

The Correct Answer is D

A) Place the client in a supine position for the first 12 hr postoperative: Following surgery for a ruptured appendix, placing the child in a supine position for the first 12 hours can be inappropriate. It may be more beneficial to position the child in a semi-Fowler's position to promote drainage of any remaining infection and reduce the risk of respiratory complications.

B) Pack the open wound with a dry gauze dressing: For a postoperative wound following a ruptured appendix, using a dry gauze dressing might not be the best practice. A moist dressing can promote better healing and reduce the risk of infection. Wet-to-dry or other appropriate dressings are typically recommended based on the surgeon's instructions.

C) Administer naproxen orally for pain 30 min prior to ambulation: While managing pain is important, naproxen is a nonsteroidal anti-inflammatory drug (NSAID) that is typically not the first choice for postoperative pain management in children. Additionally, oral medication might not be recommended immediately post-surgery, especially if the child has an NG tube or other contraindications for oral intake.

D) Maintain an NG tube on low intermittent suction until bowel sounds return: This is a standard postoperative practice for children who have had surgery for a ruptured appendix. The NG tube helps to decompress the stomach, preventing vomiting and aspiration, and helps manage bowel function until normal activity resumes, which is crucial for postoperative recovery.

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Correct Answer is C

Explanation

A) Administering risperidone 25 mg IM: Administering risperidone intramuscularly is generally used for managing severe psychotic symptoms and not typically indicated for acute panic attacks. Without prior prescription or proper assessment, this action may be unsafe and inappropriate.

B) Teaching the client how to perform guided imagery: Guided imagery is an effective technique for managing anxiety over the long term, but it is not suitable for immediate relief during a severe panic attack. The client may not be able to focus or learn new techniques when experiencing extreme distress.

C) Staying with the client until the panic attack subsides: Providing immediate emotional support and reassurance by staying with the client helps reduce the intensity of the panic attack. The nurse's presence can help the client feel safer and more secure, facilitating a return to a calmer state.

D) Encouraging the client to take quick, shallow breaths: Quick, shallow breaths can exacerbate hyperventilation and increase symptoms like dizziness and lightheadedness. It is more beneficial to encourage slow, deep breathing to help regulate breathing patterns and reduce panic symptoms.

A. Maintain the client on bed rest for 48 hr following surgery. B. Check the tubing for kinks and blood clots at least every 2 hr. C. Irrigate the client's bladder continuously using 5% dextrose in Ringer's lactate. D. Remove the catheter if the client reports severe bladder spasms.

Correct Answer is B

Explanation

A) Maintain the client on bed rest for 48 hr following surgery: While some bed rest is recommended initially post-surgery, maintaining bed rest for 48 hours is excessive and can increase the risk of complications like deep vein thrombosis. Early mobilization is generally encouraged to enhance recovery.

B) Check the tubing for kinks and blood clots at least every 2 hr: Regularly checking the catheter tubing for kinks and blood clots is essential to ensure the continuous flow of urine and prevent catheter blockage. This can help in reducing the risk of complications such as bladder distension and urinary retention.

C) Irrigate the client's bladder continuously using 5% dextrose in Ringer's lactate: Continuous bladder irrigation is often done post-TURP to prevent clot formation, but 5% dextrose in Ringer's lactate is not the recommended solution. Typically, normal saline is used to minimize the risk of electrolyte imbalance and maintain the correct osmolarity.

D) Remove the catheter if the client reports severe bladder spasms: Severe bladder spasms can occur post-TURP, but removing the catheter is not the immediate solution. The catheter is necessary for drainage and should be managed with antispasmodic medications or adjusting the irrigation flow rather than removal.

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A nurse is receiving postoperative report for a school-age child following surgery for a ruptured appendix. Which of the following prescriptions should the nurse expect?

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