At 0600 while admitting a woman for a scheduled repeat cesarean section, the client tells the nurse that she drank a cup of coffee at 0400 because she wanted to avoid getting a headache. Which action should the nurse take first?- Nurselytic

Question 1 of 5

At 0600 while admitting a woman for a scheduled repeat cesarean section, the client tells the nurse that she drank a cup of coffee at 0400 because she wanted to avoid getting a headache. Which action should the nurse take first?

A. Cancel the surgery B. Inform the anesthesia care provider C. Ask the client if she has had any other liquids D. Proceed with routine preparations

Correct Answer: B

Rationale: Drinking liquids before surgery can increase the risk of aspiration during anesthesia. Therefore, the anesthesia care provider must be informed immediately to determine how to proceed, as this could delay or alter the surgical plan.

Question 2 of 5

The nurse is administering an intradermal injection for a tuberculosis skin test. Which technique should the nurse use?

A. Use a 25-gauge needle at a 90-degree angle B. Use a 27-gauge needle at a 15-degree angle C. Use a 22-gauge needle at a 45-degree angle D. Use a 20-gauge needle at a 90-degree angle

Correct Answer: B

Rationale: An intradermal injection for a tuberculosis skin test should be administered using a 27-gauge needle at a 15-degree angle. This technique ensures that the medication is delivered into the dermis layer of the skin.

Question 3 of 5

When teaching a group of mothers of young children about emergency care for poisoning, which of the following statements should be included?

A. Induce vomiting immediately after the poison ingestion B. Call the local Poison Control Center after inducing vomiting C. Call the Poison Control Center prior to any interventions D. Take the child to the emergency department before calling the Poison Control Center

Correct Answer: C

Rationale: The Poison Control Center should be contacted before any interventions to ensure appropriate care.

Question 4 of 5

Which activity is most important for a client recovering from a hip replacement to avoid during the first few weeks of recovery?

A. Sitting in a chair for short periods B. Crossing the legs while sitting C. Walking with assistance D. Performing light stretching exercises

Correct Answer: B

Rationale: Crossing the legs after a hip replacement can increase the risk of hip dislocation. Clients should be advised to avoid crossing their legs during recovery to protect the new joint.

Question 5 of 5

An older client is admitted to the intensive care unit unconscious after several days of vomiting and diarrhea. The nurse inserts a urinary catheter and observes dark amber urine output. Which intervention should the nurse implement first?

A. Begin dopamine infusion at 2 mcg/kg/minute. B. Begin potassium chloride 10 mEq over 1 hour. C. Give a bolus of 0.9% sodium chloride 1000 mL over 30 minutes. D. Administer promethazine 25 mg IV push.

Correct Answer: C

Rationale: A fluid bolus is the first step in stabilizing a client with hypovolemic symptoms.

Nurselytic

HESI RN

HESI RN

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