A nurse working in the post-anesthesia care unit (PACU) is caring for a post-operative client that just had pelvic surgery. The nurse anticipates assessing for what post-operative complaint related to spinal anesthesia?

Weakness in upper extremities

Headache

Increased respiratory rate

Blurred vision

Answer and Explanation

The Correct Answer is B

A. Weakness in upper extremities: Spinal anesthesia generally affects the lower body, so weakness in the upper extremities is not typically related to this type of anesthesia.
B. Headache: This is the correct choice. A headache is a common post-operative complaint related to spinal anesthesia, often caused by a spinal fluid leak, leading to a post-dural puncture headache.
C. Increased respiratory rate: Spinal anesthesia typically does not affect respiratory rate significantly; it mainly impacts sensation and motor function below the level of anesthesia.
D. Blurred vision: This is not a common issue directly related to spinal anesthesia. Visual disturbances are not typical post-operative complaints associated with spinal anesthesia.

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Correct Answer is D

Explanation

A. Level of consciousness: While important, it follows the assessment of vital signs to ensure the client's overall stability.
B. Condition of drains: This is relevant but not as immediate as assessing the stability of vital signs.
C. Appearance of the surgical dressing: This is important but secondary to ensuring the client’s vital signs are stable.
D. Stability of vital signs: This is the most critical next assessment after ensuring a patent airway, as vital signs reflect the client's immediate physiological status and stability.

A. The client who takes medications for occasional anxiety B. The client admitted with a mild pleural effusion C. The client who has had diarrhea for the past 48 hours D. The client admitted with an acute renal injury E. The client admitted for treatment of asthmatic bronchitis

Correct Answer is ["C","D"]

Explanation

A. The client who takes medications for occasional anxiety: Anxiety medications are not typically associated with metabolic acidosis.
B. The client admitted with a mild pleural effusion: A mild pleural effusion is more related to fluid accumulation and respiratory issues rather than metabolic acidosis.
C. The client who has had diarrhea for the past 48 hours: Prolonged diarrhea can lead to loss of bicarbonate, resulting in metabolic acidosis.
D. The client admitted with an acute renal injury: Acute renal injury impairs the kidneys' ability to excrete acids and can lead to metabolic acidosis.
E. The client admitted for treatment of asthmatic bronchitis: Asthmatic bronchitis typically involves respiratory issues rather than metabolic acidosis.

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A nurse working in the post-anesthesia care unit (PACU) is caring for a post-operative client that just had pelvic surgery. The nurse anticipates assessing for what post-operative complaint related to spinal anesthesia?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

After ensuring a postoperative client has a patent airway, what is the next most important nursing assessment?

Correct Answer is D

Explanation

The nurse identifies that which of the following clients is at risk for developing metabolic acidosis? (Select All That Apply)

Correct Answer is ["C","D"]

Explanation

A client indicates to the nurse a pain level of 8 out of 10. The nurse notes the client has an order for morphine 4 mg IV Q 6 hr PRN for moderate to severe pain. The client's blood pressure is 80/54 mm Hg, respirations 10 breaths/min, and pulse 62 beats/min. Which action should the nurse take?

The pharmacy just delivered the sustained-release opioid tablets newly prescribed for a client with a gastrostomy tube. What should the nurse do when preparing to provide this medication to the client?

The client is NPO and is receiving total parenteral nutrition (TPN) via a peripherally inserted central catheter. Which precautions should the nurse implement? (Select All That Apply)

A nurse is monitoring a client who is receiving IV fluid. Which clinical findings indicate that the client has fluid overload?

The nurse is providing teaching to the client about the use of vitamins and supplements. The nurse would state that vitamin D has a major role in which process?

The client has received IV solution for three (3) days through a 20-gauge IV catheter placed in the left hand. On morning rounds, the nurse notes the IV site is tender to palpation and a red streak has formed. Which intervention should the nurse implement first?