Hesi RN Medical Surg

Extract:

Question 1 of 5

The nurse is caring for a client in the post anesthesia care unit (PACU) who underwent a thoracotomy two hours ago. The nurse observes vital signs of a heart rate of 140 beats/minute, a respiratory rate of 26 breaths/minute, and a blood pressure of 140/90 mm Hg. Which intervention is most important for the nurse to implement?

A. Administer IV fluid bolus as prescribed by the healthcare provider. B. Encourage the client to splint the Incision with a pillow to cough and deep breathe. C. Medicate for pain and monitor vital signs according to protocol. D. Apply oxygen at 10 L/minute via non-rebreather mask and monitor pulse oximeter.

Correct Answer: C

Rationale: Pain medication addresses tachycardia and tachypnea likely caused by postoperative pain, stabilizing vital signs.

Question 2 of 5

Correct Answer:

Rationale:

Question 3 of 5

Correct Answer:

Rationale:

Question 4 of 5

Correct Answer:

Rationale:

Question 5 of 5

Correct Answer:

Rationale:

Similar Questions

An adult client who was recently diagnosed with glaucoma tells the nurse, 'It feels like I am driving through a tunnel.' The client expresses great concern about going blind. Which nursing instruction is most important for the nurse to provide this client?

Based on the client's laboratory findings, the nurse recognizes that the client is having an acute gout attack and is most at risk for SwellingBruisingInfectionInflammationRash and DiscolorationErythemaCyanosisPallorEcchymosis in his affected joint.

A 59-year-old male client presents to the clinic reporting pain in the right great toe. For each medication used to treat gout, choose the most likely therapeutic outcome and the teaching associated with the medication.

The nurse is caring for a client in the post anesthesia care unit (PACU) who underwent a thoracotomy two hours ago. The nurse observes vital signs of a heart rate of 140 beats/minute, a respiratory rate of 26 breaths/minute, and a blood pressure of 140/90 mm Hg. Which intervention is most important for the nurse to implement?

Based on the client's history and the assessment data, what action(s) should the nurse anticipate? Select all that apply.

Hesi RN Medical Surg | Nurselytic

Nurselytic

HESI RN

HESI RN