The nurse is caring for a client who had a bowel resection 2 hours ago for adenocarcinoma removal. It would be necessary for the nurse to immediately notify the surgeon if the client's assessment revealed:

no bowel sounds noted during the assessment.

an SPO2 which registers 90% while the client is asleep.

increasing abdominal distention.

a small amount of green-tinged fluid from the nasogastric tube.

Answer and Explanation

The Correct Answer is C

A. The absence of bowel sounds shortly after surgery is not uncommon, especially within the first few hours, and does not necessarily indicate a complication at this time.
B. An SPO2 of 90% while the client is asleep may warrant attention, but it is not as critical as signs of a potential surgical complication. The nurse should assess the patient's respiratory status and consider interventions, but immediate notification to the surgeon is not required.
C. Increasing abdominal distention is a concerning sign that may indicate complications such as an anastomotic leak or bowel obstruction, which requires immediate evaluation and possible intervention by the surgeon.
D. A small amount of green-tinged fluid from the nasogastric tube is generally expected postoperatively and does not necessarily indicate a problem, thus does not require immediate notification of the surgeon.

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Correct Answer is A

Explanation

A. Continuing antiepileptic drugs is crucial in patients with brain tumors, as these medications help prevent seizure activity, which is a common complication associated with brain tumors and surgical procedures.
B. While pain control is important, the specific medications used for postoperative pain management are determined after surgery; patients should be informed about general pain management strategies rather than specific drug administration.
C. Aspirin, an anticoagulant, should typically be stopped before surgery to reduce the risk of bleeding complications; therefore, patients should not continue taking it unless specifically directed by their healthcare provider.
D. Patients are usually advised to discontinue alternative or complementary therapies before surgery due to potential interactions with anesthesia or surgical procedures, and it should be clarified with the healthcare provider before proceeding.

A. Prone (supported) position B. Dorsal recumbent position C. Lateral recumbent D. Semi-Fowler's position

Correct Answer is D

Explanation

A. The prone position is not suitable post-craniotomy as it can increase intracranial pressure and may compromise respiratory function.
B. The dorsal recumbent position is not ideal for patients post-craniotomy, as it can hinder optimal intracranial pressure management.
C. The lateral recumbent position is generally avoided immediately after craniotomy to prevent pressure on the surgical site and ensure proper cerebral perfusion.
D. The Semi-Fowler's position helps reduce intracranial pressure, promotes venous drainage, and is generally recommended for post-operative care following a craniotomy.

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The nurse is caring for a client who had a bowel resection 2 hours ago for adenocarcinoma removal. It would be necessary for the nurse to immediately notify the surgeon if the client's assessment revealed:

Nursing Test Bank

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Correct Answer is D

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