The nurse has just reassessed the condition of a postoperative client who was admitted 1 hour ago to the surgical
unit. The nurse plans to monitor which
... [Show More] parameter most carefully during the next hour?
1. Urinary output of 20 mL/hour
2. Temperature of 37.6°C (99.6°F)
3. Blood pressure of 100/70 mm Hg
4. Serous drainage on the surgical dressing
The nurse is teaching a client about coughing and deep-breathing techniques to prevent postoperative
complications. Which statement is most appropriate for the nurse to make to the client at this time as it relates to
these techniques?
1. "Use of an incentive spirometer will help prevent pneumonia."
2. "Close monitoring of your oxygen saturation will detect hypoxemia."
3. "Administration of intravenous fluids will prevent or treat fluid imbalance."
4. "Early ambulation and administration of blood thinners will prevent pulmonary
embolism."
The nurse is creating a plan of care for a client scheduled for surgery. The nurse should include which activity in the
nursing care plan for the client on the day of surgery?
1. Avoid oral hygiene and rinsing with mouthwash.
2. Verify that the client has not eaten for the last 24 hours.
3. Have the client void immediately before going into surgery.
4. Report immediately any slight increase in blood pressure or pulse.
A client with a gastric ulcer is scheduled for surgery. The client cannot sign the operative consent form because of
sedation from opioid analgesics that have been administered. The nurse should take which most appropriate
action in the care of this client?
1. Obtain a court order for the surgery.
2. Have the charge nurse sign the informed consent immediately.
3. Send the client to surgery without the consent form being signed.
4. Obtain a telephone consent from a family member, following agency policy.
A preoperative client expresses anxiety to the nurse about upcoming surgery. Which response by the nurse is most
likely to stimulate further discussion between the client and the nurse?
1. "If it's any help, everyone is nervous before surgery."
2. "I will be happy to explain the entire surgical procedure to you [Show Less]