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Exhibits

The nurse is stabilizing the client and preparing her for surgery.
Which goals should the nurse prioritize in the plan of care for the client while in the emergency department (ED)? Select all that apply.

Infection prevention related to appendicitis

Relief of acute pain

Client education about diagnosis and plan of care

Effective coping with illness-related anxiety

Prevention of deep vein thrombosis related to immobility

Promotion of bowel routine

Fluid volume management

Answer and Explanation

Correct Answer : A,B,C,D,G

Choice A reason:

Infection prevention is crucial in managing appendicitis. Administering preoperative antibiotics, such as cefazolin, helps prevent surgical site infections and other complications. This aligns with standard care protocols for appendicitis patients.

Choice B reason:

Relieving acute pain is a priority in appendicitis care. Administering analgesics, including opioids, acetaminophen, and NSAIDs, effectively manages pain and reduces inflammation. Providing distraction techniques can also help alleviate discomfort until pain relief is achieved.

Choice C reason:

Client education about the diagnosis and plan of care is essential. Informing the patient about appendicitis, the surgical procedure, and postoperative expectations reduces anxiety and promotes cooperation. Effective communication enhances patient outcomes and satisfaction.

Choice D reason:

Effective coping with illness-related anxiety is important. Providing emotional support and addressing concerns can help the patient manage anxiety associated with the diagnosis and impending surgery. This approach contributes to overall well-being and recovery.

Choice G reason:

Fluid volume management is vital in appendicitis care. Administering intravenous fluids, such as Ringer's lactate, maintains hydration, supports renal function, and prepares the patient for surgery. Proper fluid balance is essential for optimal physiological function.

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Correct Answer is A

Explanation

Choice A reason: Eliminating whole milk and dairy servings of ice cream is an appropriate choice for a client with cholecystitis. These foods are high in fat, and a low-fat diet is recommended for managing cholecystitis. High-fat foods can stimulate the gallbladder to contract, which can exacerbate symptoms and cause pain. By removing these high-fat items from their diet, the client is following the recommended dietary guidelines for managing cholecystitis.

Choice B reason: Eliminating citrus fruit and melon with a salt substitute does not specifically address the dietary recommendations for cholecystitis. While citrus fruits and melon are generally healthy choices, they are not high in fat and do not need to be eliminated from the diet. Additionally, using a salt substitute does not have a significant impact on cholecystitis management.

Choice C reason: Eliminating pasta with herbal butter and no meat sauce is not necessary for managing cholecystitis. Pasta itself is not high in fat, and using herbal butter instead of regular butter can be a lower-fat option. As long as the pasta dish is prepared with low-fat ingredients, it can be part of a cholecystitis-friendly diet.

Choice D reason: Eliminating canned vegetables with additional table salt does not specifically address the dietary recommendations for cholecystitis. While it is generally a good idea to limit sodium intake for overall health, this recommendation is more relevant for managing conditions like hypertension. The focus for cholecystitis management should be on reducing dietary fat rather than sodium.

Correct Answer is ["56"]

Explanation

Step-by-Step Calculation:

Step 1: Convert liters to milliliters (mL) 2 liters × 1000 mL per liter = 2000 mL

Step 2: Calculate the total number of drops to be infused 2000 mL × 20 gtt per mL = 40000 gtt

Step 3: Convert hours to minutes 12 hours × 60 minutes per hour = 720 minutes

Step 4: Calculate the drops per minute 40000 gtt ÷ 720 minutes = 55.56

Step 5: Round to the nearest whole number 56 gtt/min

Answer: 56 gtt/min

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Exhibits The nurse is stabilizing the client and preparing her for surgery. Which goals should the nurse prioritize in the plan of care for the client while in the emergency department (ED)? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

After teaching a client newly diagnosed with cholecystitis about recommended diet changes, the nurse evaluates the client's learning. Which food choices eliminated by the client indicate to the nurse that teaching has been successful?

Correct Answer is A

Explanation

A client receives a prescription for 2 liters of lactated Ringer's IV to be infused over 12 hours. The IV administration set delivers 20 gtt/mL. How many gtt/min should the nurse regulate the infusion? (Enter numerical value only. If rounding is required, round to the nearest whole number.)

Correct Answer is ["56"]

Explanation

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Exhibits

The nurse is stabilizing the client and preparing her for surgery.
Which goals should the nurse prioritize in the plan of care for the client while in the emergency department (ED)? Select all that apply.