A nurse is updating a postoperative client's plan of care. The nurse should include which of the following as the priority interventions?
Reposition the client frequently.
Instruct the client to use the incentive spirometer.
Increase the amount of time the client spends out of bed each day.
Ensure the client consumes an adequate amount of fluids.
The Correct Answer is B
A. Reposition the client frequently: While repositioning is important for preventing pressure ulcers and maintaining comfort, it may not be the priority immediately postoperatively compared to other interventions.
B. Instruct the client to use the incentive spirometer: This is the correct answer. Incentive spirometry helps prevent atelectasis and respiratory complications postoperatively, making it a priority intervention to include in the plan of care.
C. Increase the amount of time the client spends out of bed each day: Early ambulation is important for preventing complications such as deep vein thrombosis and pneumonia, but it may not be the priority immediately postoperatively depending on the client's condition and surgical procedure.
D. Ensure the client consumes an adequate amount of fluids: While hydration is important for postoperative recovery, ensuring adequate fluid intake may not be the priority compared to interventions aimed at preventing respiratory complications such as atelectasis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Observe staff medication administration procedures: While observation can provide valuable insights into workflow and potential areas for improvement, it may not address the underlying causes of medication errors or provide comprehensive data for quality improvement efforts.
B. Require staff to complete a medication administration review module: Education and training are important components of improving medication safety, but they may not be the most
immediate or effective response to addressing an elevated rate of medication errors.
C. Identify data that should be collected related to medication errors: This is the correct answer.
Before implementing interventions to address medication errors, it is important to gather comprehensive data on the types, causes, and frequency of errors. This data will help identify specific areas for improvement and guide the development of targeted interventions.
D. Re-evaluate staff performance in relation to the established standard: While ongoing evaluation of staff performance is important for maintaining quality care, it may not be the most appropriate first step when addressing an elevated rate of medication errors. Gathering data on medication errors and their contributing factors is essential for understanding the root causes of the problem and developing effective solutions.
Correct Answer is C
Explanation
A. Surgical record: While the surgical record may provide information about the procedure and immediate postoperative care, it may not specifically address the criteria or timing for removal of urinary catheters.
B. Provider's prescription: The provider's prescription may indicate the initial insertion of the urinary catheter but may not provide guidance on when it should be removed based on clinical indicators or best practices.
C. Critical pathway: This is the correct answer. A critical pathway, also known as a clinical pathway or care pathway, is a multidisciplinary tool that outlines evidence-based guidelines and timelines for the management of specific patient populations or conditions. Developing a
standard for removal of urinary catheters following colon resection would involve using a critical pathway to establish best practices and optimize patient outcomes.
D. Maslow's hierarchy of needs: Maslow's hierarchy of needs is a framework for understanding human motivation and behavior, particularly related to meeting physiological and psychological needs. While it may inform nursing care in general, it is not a specific resource for developing clinical standards for urinary catheter removal.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.
