An older client is hospitalized after an operation. When assessing the client for postoperative infection, the nurse places priority on which assessment?
a. Change in behavior
b. Daily white blood cell count
c. Presence of fever and chills
d. Tolerance of increasing activity A
A preoperati...
An older client is hospitalized after an operation. When assessing the client
for postoperative infection, the nurse places priority on which assessment?
a. Change in behavior
b. Daily white blood cell count
c. Presence of fever and chills
d. Tolerance of increasing
activity A
A preoperative nurse is assessing a client prior to surgery. Which
information would be most important for the nurse to relay to the surgical
team?
a. Allergy to bee and wasp stings
b. History of lactose intolerance
c. No previous experience with
surgery d. Use of multiple herbs and
supplements D
A nurse works on the postoperative floor and has four clients who are being
discharged tomorrow. Which one has the greatest need for the nurse to
consult other members of the health care team for post-discharge care?
a. Married young adult who is the primary caregiver for children
b. Middle-aged client who is post knee replacement, needs
physical therapy c. Older adult who lives at home despite some
memory loss
d. Young client who lives alone, has family and
friends nearby C
A clinic nurse is teaching a client prior to surgery. The client does not seem
to comprehend the teaching, forgets a lot of what is said, and asks the same
questions again and again. What action by the nurse is best?
a. Assess the client for anxiety.
b. Break the information into smaller bits.
c. Give the client written information.
d. Review the information
again. A
An inpatient nurse brings an informed consent form to a client for
an operation scheduled for tomorrow. The client asks about possible
complications from the operation. What response by the nurse is
best?
a. Answer the questions and document that teaching
was done. b. Do not have the client sign the consent
and call the surgeon.
c. Have the client sign the consent, then call the surgeon.
d. Remind the client of what teaching the surgeon has done.
,B
A client has a great deal of pain when coughing and deep breathing after
abdominal surgery despite having pain medication. What action by the
nurse is best?
a. Call the provider to request more
analgesia. b. Demonstrate how to splint
the incision.
c. Have the client take shallower breaths.
d. Tell the client a little pain is
expected. B
A nurse is giving a client instructions for showering with special
antimicrobial soap the night before surgery. What instruction is most
appropriate?
a. "After you wash the surgical site, shave that area with your
own razor." b. "Be sure to wash the area where you will have
surgery very thoroughly."
c. "Use a washcloth to wash the surgical site; do not take a full shower or
bath."
d. "Wash the surgical site first, then shampoo and wash the rest of
your body." B
A postoperative client has an abdominal drain. What assessment by the
nurse indicates that goals for the priority client problems related to the drain
are being met?
a. Drainage from the surgical site is 30 mL less than
yesterday. b. There is no redness, warmth, or drainage
at the insertion site.
c. The client reports adequate pain control with medications.
d. Urine is clear yellow and urine output is greater than
40 mL/hr. B
A client waiting for surgery is very anxious. What intervention can the nurse
delegate to the unlicensed assistive personnel (UAP)?
a. Assess the client's
anxiety. b. Give the client
a back rub.
c. Remind the client to turn.
d. Teach about postoperative
care. B
A client in the preoperative holding room has received sedation and now
needs to urinate. What action by the nurse is best?
, a. Allow the client to walk to the bathroom.
b. Delegate assisting the client to the
nurse's aide. c. Give the client a bedpan or
urinal to use.
d. Insert a urinary catheter now instead of waiting.
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