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Questions 149

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Question 1 of 5

The physician has ordered a paracentesis for a client with severe abdominal ascites. Before the procedure, the nurse should:

Correct Answer: A

Rationale: Providing a urinal allows the client to empty their bladder, reducing the risk of bladder puncture during paracentesis.

Question 2 of 5

A woman has undergone a mastectomy of her right breast and has been brought to the recovery unit. The nurse explains that the client should

Correct Answer: A

Rationale: Elevating the arm on a pillow reduces lymphedema risk post-mastectomy by promoting lymphatic drainage.

Question 3 of 5

The client is admitted to the unit after a motor vehicle accident with a temperature of 102°F rectally. The most likely explanations for the elevated temperature is that:

Correct Answer: B

Rationale: Infection from abrasions is the most likely cause of fever post-accident, as it's a common complication.

Question 4 of 5

The physician has ordered that a serum trough level be drawn for a medication. Which of the following is the correct time to draw blood for a trough level?

Correct Answer: D

Rationale: A trough level is drawn immediately before a scheduled dose (
D) to measure the lowest drug concentration in the blood. Other times (A, B,
C) do not reflect the trough level.

Question 5 of 5

Which would be included in the nursing care plan of a client experiencing severe delirium tremens?

Correct Answer: B

Rationale: Keeping closet and bathroom doors closed minimizes visual stimuli that could exacerbate hallucinations or confusion in delirium tremens, promoting a safe environment.

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