A client has undergone a nephrectomy and is placed under observation after a urethral catheter insertion. As part of the nursing care plan, the nurse records the color of drainage from each tube and catheter. Which of the ff is the reason for this?

Correct Answer: B

Rationale: Recording the color of drainage from each tube and catheter is crucial in the nursing care plan as it provides a means for further comparison and evaluation. Changes in the color of drainage can indicate potential issues such as infection, bleeding, or other complications post-surgery. By monitoring the color of drainage, the nurse can identify any abnormal changes early on and take appropriate actions to address them promptly. This practice helps in assessing the patient's condition and ensuring optimal recovery and healing after the surgery.

Correct Answer: A

Rationale: The patient's presentation suggests that he may be suffering from hypermagnesemia (high magnesium levels) due to excessive ingestion of antacid tablets. Symptoms of hypermagnesemia can include flushing, weakness, and low blood pressure. A serum magnesium level of 11mEq/L is consistent with hypermagnesemia. In this scenario, the other values (2mEq/L, 5mEq/L, 1mEq/L) are unlikely to be the correct magnesium level based on the patient's symptoms and history of antacid ingestion.

Correct Answer: D

Rationale: A client with a history of cardiac dysrhythmias and dehydration requires careful monitoring and management of fluid and electrolyte balance. The most appropriate intervention for rapid correction of dehydration in this scenario is a rapid IV infusion of an electrolyte and glucose solution. This method allows for the quick replacement of fluids and essential electrolytes to restore the client's hydration status efficiently and effectively. Administering fluids orally may not be adequate in this situation, and NG replacement of fluids and nutrients may not be necessary if the client's condition can be managed through IV therapy. Therefore, option D is the most appropriate choice for this client.

Correct Answer: D

Rationale: Vitamin D is essential for the absorption of calcium in the body. Without sufficient vitamin D, the absorption of calcium from the diet is impaired, leading to potential issues with calcium deficiency. Vitamin A, B, and C do not have a direct role in the absorption of calcium. Vitamin D helps regulate the amount of calcium and phosphate in the body, which are necessary for bone health, muscle function, and other important processes. Therefore, a lack of Vitamin D can contribute to weakened bones and potential health problems related to calcium deficiency.

Correct Answer: C

Rationale: The precaution a nurse should take to minimize the risk of deaths occurring when potassium chloride is used incorrectly to flush a lock or central venous catheter is to read labels carefully on vials containing flush solutions for locks. This is essential to ensure that the correct solution is being used and to prevent accidental administration of potassium chloride, which can be fatal if used inappropriately. By carefully checking the labels, the nurse can confirm that they are using the correct flush solution and avoid any harmful errors. This simple precaution can help in ensuring patient safety and preventing adverse outcomes.