The nurse is continuing to assist in the care of the client post-surgery. The test-taker must interpret the following exhibits to answer the question.
The nurse is assisting with evaluating the client’s responses to interventions.
Oxygen saturation
Hemoglobin
Mental status
Urinary output
WBC count
Correct Answer : C,E
Choice A rationale:
Oxygen saturation is not provided in the exhibits, so there is no data available to evaluate if it indicates improvement in the client’s condition. While oxygen saturation is an important indicator of respiratory function and overall oxygenation status, its absence means it cannot be used to assess the client’s progress in this case.
Choice B rationale:
Hemoglobin levels decreased from 14 g/dL on postoperative day 1 to 10.5 g/dL on postoperative day 2. This decline in hemoglobin levels suggests that the client may be experiencing blood loss or anemia, which is not indicative of improvement. Generally, an improvement in the client’s condition would be reflected in stable or increasing hemoglobin levels rather than a decrease.
Choice C rationale:
Mental status is an important indicator of overall recovery and improvement. On postoperative day 2, the client is described as drowsy but alert to voice. This level of responsiveness indicates an improvement in mental status compared to what might be expected immediately post-surgery. A client who is drowsy but still responsive to verbal stimuli is showing signs of regaining consciousness and cognitive function, which is a positive sign of recovery.
Choice D rationale:
Urinary output is not provided in the exhibits, so there is no data available to assess if it indicates improvement. Urinary output is an important measure of kidney function and fluid status, but without specific data, it cannot be used to determine the client’s progress.
Choice E rationale:
The WBC count increased from 7,000/mm³ on day 1 to 8,500/mm³ on day 2, which is within the normal range and indicates a healthy immune response.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Intermittent abdominal pain is not typically associated with total parenteral nutrition (TPN) or burn injuries.
Choice B rationale
Increased serum glucose levels can occur with TPN due to the high glucose content of the solution. This should be monitored closely, especially in patients with burns, who may have altered glucose metabolism.
Choice C rationale
Absent bowel sounds are not typically associated with TPN or burn injuries.
Choice D rationale
Decreased calcium levels are not typically associated with TPN or burn injuries.
Correct Answer is ["1.5"]
Explanation
Step 1: Identify the order. The order is for 15,000 units of heparin.
Step 2: Identify the available medication. The available medication is heparin 10,000 units/mL.
Step 3: Calculate the dose. To find out how many mL to administer, divide the number of units ordered by the number of units per mL. So, 15,000 units ÷ 10,000 units/mL = 1.5 mL. So, the nurse should administer 1.5 mL of heparin with each dose.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.