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Questions 148

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Question 1 of 5

The nurse is evaluating the intake and output of a client for the first 12 hours following an abdominal cholecystectomy. Which finding should be reported to the physician?

Correct Answer: D

Rationale: Absence of stool post-cholecystectomy may indicate a complication like ileus or obstruction, requiring physician evaluation.

Question 2 of 5

Which of the following tasks are appropriate for the nurse to delegate to unlicensed assistive personnel? Select all that apply.

Correct Answer: B,C,E

Rationale: Unlicensed assistive personnel can perform routine tasks like checking routine vital signs (
B), measuring urinary output (
C), and assisting with ambulation (E). Checking vital signs in an acutely ill client (
A) and monitoring a transfusion (
D) require a nurse's assessment skills.

Question 3 of 5

Which statement by the client regarding sickle cell disease indicates a need for further teaching?

Correct Answer: B

Rationale: Alcohol, including red wine, can cause dehydration and increase the risk of sickle cell crisis, so it should be avoided. Other statements are correct.

Question 4 of 5

An infant with a ventricular septal defect is discharged with a prescription for lanoxin elixir 0.01 mg PO q 12 hrs. The bottle is labeled 0.10 mg per 1/2 tsp. The nurse should instruct the mother to:

Correct Answer: B

Rationale: The calibrated dropper ensures accurate dosing of Lanoxin (digoxin), critical for preventing toxicity in infants.

Question 5 of 5

The nurse is caring for a client who just had a supratentorial craniotomy to remove a tumor. The nurse will implement which of the following in the client's plan of care? Select all that apply.

Correct Answer: B, D, E

Rationale: Monitoring pupils, respiratory status, and excessive drainage are critical to detect complications like increased intracranial pressure. Positioning flat is incorrect; the head should be elevated.

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