The nurse assesses a client who had bilateral total knee replacements (TKR) four hours ago. The nurse notes that the dressing on the client's right knee is saturated with serosanguineous drainage. Which action should the nurse implement?

Confirm that the continuous passive motion device is intact.

Withhold next scheduled dose of low molecular weight heparin.

Determine if the wound drainage device is functioning correctly.

Monitor the client's current white blood cell count (WBC).

Answer and Explanation

The Correct Answer is C

Choice A reason: Confirming the continuous passive motion device is intact is important but secondary to assessing the source of the drainage.

Choice B reason: Withholding the next dose of low molecular weight heparin should only be done based on a healthcare provider's order after assessing the situation.

Choice C reason: Determining if the wound drainage device is functioning correctly is essential to manage the excessive drainage and ensure that there is no blockage or malfunction.

Choice D reason: Monitoring the client's WBC count is important for detecting infection but is not the immediate action required for managing active drainage.

Nursing Test Bank

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Correct Answer is ["1000"]

Explanation

Calculation Steps:

Step 1: Determine the total volume to be infused: 500 mL. Result = 500 mL.

Step 2: Convert time from minutes to hours: 30 minutes ÷ 60 minutes/hour = 0.5 hours. Result = 0.5 hours.

Step 3: Calculate the infusion rate: 500 mL ÷ 0.5 hours = 1000 mL/hour.

Result = 1000 mL/hour.

A. Bowl of oatmeal. B. Bacon slices. C. Raisin bran muffins. D. Cup of raspberries. E. Scrambled eggs.

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

Explanation

Choice A reason: Oatmeal is high in fiber and helps soften stools, making it a good option for someone with hemorrhoids.

Choice B reason: Bacon slices are not high in fiber and are not recommended.

Choice C reason: Raisin bran muffins are high in fiber and beneficial for managing hemorrhoids.

Choice D reason: Raspberries are high in fiber and are a good choice for a high-fiber diet.

Choice E reason: Scrambled eggs do not contain fiber and are not particularly beneficial for increasing fiber intake.

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The nurse assesses a client who had bilateral total knee replacements (TKR) four hours ago. The nurse notes that the dressing on the client's right knee is saturated with serosanguineous drainage. Which action should the nurse implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The healthcare provider (HCP) prescribes 0.9% normal saline 500 mL IV bolus to be infused over 30 minutes. How many mL/hour should the nurse set the infusion pump? (Enter numerical value only.)

Correct Answer is ["1000"]

Explanation

A client with hemorrhoids asks for information about a high fiber diet. Which breakfast menu item(s) should the nurse suggest? Select all that apply.

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

Explanation

The nurse caring for a child with mononucleosis can expect the child to exhibit which symptoms?

A client expresses concern about receiving proper care in accordance with the client's religion. Which action is best for the nurse to take?

A client's catheter bag was left on the client's bed for a prolonged period of time, and the client develops a urinary tract infection (UTI). In evaluating the cause of the infection, which should the nurse identify as the infection reservoir?

The friend of a nurse who works in an acute care hospital asks the nurse to review the adult daughter's electronic medical record (EMR) to determine if she is honestly disclosing her medical condition. The nurse's reply should include which information? Select all that apply.

The nurse is performing tracheostomy care for a client when a code blue is called for another client on the unit who experiences a cardiopulmonary arrest. Which action should the nurse take?

A client is being treated for syndrome of inappropriate antidiuretic hormone (SIADH). On examination, the client has a weight gain of 4.4 lbs (2 kg) in 24 hours and an elevated blood pressure. Which intervention should the nurse implement first?

The school nurse is preparing a teaching pamphlet in response to requests from parents regarding an outbreak of pinworms at the local preschool. Which information about the most commonly prescribed medication, mebendazole, should be included?

A client who weighs 160 pounds receives a prescription for gentamicin 5 mg/kg/day IV in divided doses every 8 hours. How many mg should the nurse administer with each dose? (Enter numerical value only. If rounding is required, round to the nearest whole number.)