A client is 4 hours postoperative following abdominal surgery. The client's blood pressure has dropped from 120/80 mm Hg to 90/60 mm Hg. What action should the nurse take first?

Correct Answer: B

Rationale: The correct answer is B: Check the surgical site for bleeding. This is the first action the nurse should take as a sudden drop in blood pressure postoperatively could indicate internal bleeding, a common complication after abdominal surgery. By assessing the surgical site for bleeding, the nurse can identify and address the source of the hypotension promptly. Administering IV fluids (choice A) may be necessary but should come after determining the cause. Placing the client in Trendelenburg position (choice C) is not recommended as it can worsen venous return and increase intracranial pressure. Notifying the healthcare provider (choice D) should be done after the nurse has assessed the situation and taken immediate action.

Correct Answer: D

Rationale: The correct answer is D because the statement indicates a need for further teaching. The client should avoid solid foods for a specific period, usually 24 hours, before a colonoscopy to ensure a clear view of the colon. This helps the healthcare provider to perform the procedure effectively and reduces the risk of complications. Choices A, B, and C are incorrect because having clear liquids up to 2 hours before, taking a laxative the night before, and being sedated during the procedure are all standard preparations for a colonoscopy and do not indicate a need for further teaching.

Correct Answer: C

Rationale: The correct answer is C: Consume a low-sodium diet. Ascites in cirrhosis is often due to fluid retention caused by impaired liver function. A low-sodium diet helps to reduce fluid buildup in the body, alleviating ascites. Increasing protein intake (A) may worsen ascites by increasing fluid retention. Limiting fluid intake (B) can lead to dehydration, exacerbating the condition. Taking a daily multivitamin (D) may be beneficial for overall health but does not directly address ascites.

Correct Answer: B

Rationale: The correct answer is B: Administer pain medication as needed. In acute pancreatitis, pain management is crucial to provide comfort and improve outcomes. Pain medication helps alleviate the severe abdominal pain associated with pancreatitis. It is essential to treat pain promptly to prevent complications and improve the client's quality of life. Encouraging a high-protein diet (A) is not recommended as it may exacerbate pancreatitis symptoms. Providing small, frequent meals (C) may help reduce the workload on the pancreas, but pain management takes precedence. Increasing oral fluid intake (D) is important for hydration but does not address the primary concern of pain relief in acute pancreatitis.

Correct Answer: C

Rationale: The correct answer is C: Potassium level of 6.5 mEq/L. High potassium levels in ESRD patients can lead to life-threatening cardiac arrhythmias. Immediate action is needed to prevent complications. A: Weight gain may indicate fluid retention, but it's not an immediate concern. B: Blood pressure is elevated but not an urgent issue. D: Hemoglobin level of 10 g/dL is within the acceptable range for ESRD patients and does not require immediate action.