A patient is 1 hour postoperative following an open reduction internal fixation of the left tibia. Which of the following actions should the nurse take?

Correct Answer: A

Rationale: It is crucial to assess the neurovascular status of the extremities every 4 hours to monitor for any signs of complications such as impaired circulation or nerve damage. This frequent assessment helps in early detection of any issues that may arise postoperatively, allowing for timely intervention and prevention of potential complications.

Correct Answer: D

Rationale: Rheumatic fever can lead to cardiac complications, such as dysrhythmias. Therefore, it is essential for the nurse to monitor the child's heart rate closely for any signs of dysrhythmias. This will help in early identification and prompt management of potential cardiac issues associated with rheumatic fever.

Correct Answer: A

Rationale: During the oliguric phase of acute kidney injury, the priority is to manage fluid balance. Administering a loop diuretic helps promote diuresis and reduce fluid retention, aiding in managing the condition effectively. Providing a low-sodium diet may be beneficial but is not the priority intervention during this phase. Weighing the child weekly may be important for monitoring overall health but does not directly address the oliguric phase. Providing a high-protein diet is not typically recommended in acute kidney injury, especially during the oliguric phase.

Correct Answer: D

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: B

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.