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 B

Explanation

A) "Clean the canister and cap of the inhaler every 2 weeks": While it's important to keep the inhaler clean, it should be cleaned more frequently than every 2 weeks. Typically, cleaning is recommended at least once a week to prevent medication buildup and ensure proper functioning.

B) "Wait 1 minute between puffs of the inhaler": Waiting 1 minute between puffs allows the medication from the first puff to take effect and opens the airways, making the second puff more effective. This practice helps maximize the medication's absorption and effectiveness.

C) "Tilt your head forward and inhale rapidly while depressing the canister": The correct technique involves tilting the head slightly back, not forward, to open the airways better. Additionally, the client should inhale slowly and deeply, rather than rapidly, to ensure the medication is properly delivered to the lungs.

D) "Place your middle finger at the mouthpiece and your thumb at the top of the inhaler": This description of finger placement is incorrect. The correct technique is to place the thumb at the base of the inhaler and the index and middle fingers on the top of the canister to allow for proper grip and activation of the inhaler.

A. Diarrhea B. Bradycardia C. Tinnitus D. Tetany

Correct Answer is D

Explanation

A) Diarrhea: Metabolic alkalosis is more likely to be associated with constipation rather than diarrhea. Diarrhea is typically a cause of metabolic acidosis due to the loss of bicarbonate in stool, rather than a result of metabolic alkalosis.

B) Bradycardia: Bradycardia is not a typical manifestation of metabolic alkalosis. Alkalosis can lead to arrhythmias, but it generally does not cause a slow heart rate. Instead, tachycardia might occur as the body compensates for the altered acid-base balance.

C) Tinnitus: Tinnitus is not a common symptom of metabolic alkalosis. It is more often associated with aspirin toxicity or other conditions affecting the auditory system, rather than changes in acid-base balance.

D) Tetany: Tetany is a common manifestation of metabolic alkalosis. The alkalosis causes a decrease in ionized calcium levels, which increases neuromuscular excitability and can lead to muscle cramps, spasms, and tetany. This is a key sign for nurses to monitor as it indicates significant electrolyte disturbances associated with the alkalotic state.

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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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