The practical nurse (PN) is assisting with preparation of a client for fecal diversion surgery. While inserting an indwelling urinary catheter, the client asks if the surgical opening will be visible. Which action should the PN implement?

Ask the client if he finished the bowel sterilization prescription.

Review the client's expectations of elimination after surgery.

Verify that the client had nothing by mouth (NPO) for the past 24 hours.

Determine if this is the first indwelling catheter the client has had.

Answer and Explanation

The Correct Answer is B

A.   Asking about the bowel sterilization prescription doesn't address the client's concern regarding the visibility of the surgical opening.
B.   Reviewing the client's expectations after surgery could address the client's query about the visibility of the surgical opening and offer information regarding elimination.
C.   Verifying the NPO status is important for surgery preparation but doesn’t directly address the client's specific concern.
D.   Determining if this is the first indwelling catheter doesn’t directly address the client's immediate concern regarding the surgical opening.

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Correct Answer is A

Explanation

A. Call the healthcare provider and clarify the prescription. - If the PN suspects an error in a prescription, especially regarding a child's dosage, it's imperative to communicate concerns to the healthcare provider for clarification and potential adjustment.
B. Request verification of the prescription by the charge nurse. - While involving another nurse might provide a second opinion, it's crucial to involve the prescriber to rectify any potential prescription errors.
C. Tell the pharmacy to send an accurate child's dosage. - The prescription should be confirmed with the healthcare provider before any medication is dispensed or administered.
D. Ask another nurse if adult dosages are ever given to children. - While seeking information from peers is valuable, this situation calls for direct clarification from the prescriber to ensure proper dosing for the child.

A. Check for kinks in the drainage tubing. B. Observe the drainage again in one hour. C. Report the finding to the charge nurse. D. Stop the irrigation solution immediately

Correct Answer is C

Explanation

A. Checking for kinks in the drainage tubing might be a part of troubleshooting, but the observed clots and thick red fluid require immediate attention, so informing the charge nurse is the priority.
B. Delaying assessment for another hour could potentially exacerbate the issue if there's a problem with the irrigation or if the client's condition worsens.
C. Reporting the finding to the charge nurse is crucial as it indicates potential complications such as bleeding or clot formation that need immediate intervention.
D. Immediately stopping the irrigation solution without proper assessment and guidance could lead to complications and isn't the initial action warranted in this situation.

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The practical nurse (PN) is assisting with preparation of a client for fecal diversion surgery. While inserting an indwelling urinary catheter, the client asks if the surgical opening will be visible. Which action should the PN implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The practical nurse (PN) believes that a prescription for a child is incorrect because the dosage prescribed is the usual adult dosage. Which action should the PN take?

Correct Answer is A

Explanation

Correct Answer is C

Explanation

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