NCLEX-PN
NCLEX Perioperative Nursing Questions Questions
Extract:
Question 1 of 5
The client diagnosed with appendicitis has undergone an appendectomy. At two (2) hours postoperative, the nurse takes the vital signs and notes T 102.6°F, P 132, R 26, and BP 92/46. Which interventions should the nurse implement? List in order of priority.
Order the Items
Source Container
Increase the IV rate.
Notify the health-care provider.
Elevate the foot of the bed.
Check the abdominal dressing.
Determine if the IV antibiotics have been administered.
Correct Answer: C,A,B,D,E
Rationale: 1) Elevate foot of bed (Trendelenburg for hypotension); 2) Notify HCP (fever, tachycardia, hypotension suggest sepsis); 3) Increase IV rate (bolus for hypovolemia); 4) Check dressing (assess bleeding); 5) Confirm antibiotics (treat infection).
Question 2 of 5
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Question 3 of 5
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Question 4 of 5
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Question 5 of 5
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