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Exhibits

A client is brought to post anesthesia care unit (PACU) after an invasive procedure. Based on the two sets of vital signs in the chart tab, which action is most appropriate by the nurse?

Continue monitoring the vitals

inform the surgeon about the increase in temperature

increase intravenous fluid rates

inform the surgeon about the decrease in blood pressure

Answer and Explanation

The Correct Answer is A

A. The changes in vital signs are within expected ranges post-procedure, so continued monitoring is appropriate.

B. A temperature increase to 99°F is not significant and does not require immediate reporting.

C. No signs of hypovolemia or dehydration warrant increasing IV fluids.

D. A blood pressure decrease to 112/72 mm Hg is minimal and not concerning.

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Correct Answer is C

Explanation

A. Administering analgesics is not a priority in managing low oxygen saturation.

B. Administering oxygen is important but should follow positioning to improve oxygenation.

C. Raising the head of the bed improves lung expansion and is the priority intervention.

D. Coughing and deep breathing can follow after oxygenation is stabilized.

A. Discuss alternatives to the procedure. B. Inform the provider that the client is withdrawing consent C. Explain why this procedure is necessary. D. Remind the client the consent form has already has been signed.

Correct Answer is B

Explanation

A. While discussing alternatives may be beneficial later, it is not the priority action when consent is withdrawn.

B. Informing the provider ensures the client’s right to withdraw consent is respected and initiates appropriate communication.

C. Explaining why the procedure is necessary may feel coercive and does not prioritize the client’s autonomy.

D. Reminding the client about the signed consent form undermines their right to change their decision.

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Exhibits A client is brought to post anesthesia care unit (PACU) after an invasive procedure. Based on the two sets of vital signs in the chart tab, which action is most appropriate by the nurse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has returned to the unit on a stretcher following a surgical procedure. The client's oxygen saturation is 85%. Which of the following actions should the nurse take first?

Correct Answer is C

Explanation

A nurse is caring for a client who has provided informed consent in preparation for a procedure. The client states, "I have decided not to have the procedure." Which action should the nurse take?

Correct Answer is B

Explanation

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The nurse is preparing to transfer a client from the post-anesthesia care unit (PACU). Which assessment findings would delay the transfer of the client? (Select All that Apply.)

A client asks the nurse why they cannot consume food or liquids before surgery. Which response is most appropriate?

Which is the priority intervention for the nurse to perform in the post anesthesia care unit (PACU)?

What type of procedural information should be given to a client in preparation for ambulatory surgery? (Select All that Apply)

A nurse is teaching a newly licensed nurse about anesthesia. The nurse should include that an epidural is an example of which of the following types of anesthesia?

A nurse is caring for a client receiving Propofol for sedation during a medical procedure. Which assessment finding should the nurse prioritize when monitoring the client's response to Propofol?

Exhibits

A client is brought to post anesthesia care unit (PACU) after an invasive procedure. Based on the two sets of vital signs in the chart tab, which action is most appropriate by the nurse?