, Seizure precautions - CORRECT ANSWERS-Ensure client has IV access for seizure
medication administration.
Postoperative lab values - CORRECT ANSWERS-Report Hgb level of 8 g/dL to
provider as an indicator of postoperative hemorrhage or anemia.
ESWL procedure - CORRECT ANSWERS-Expect stone fragments in the urine after
extracorporeal shock wave lithotripsy.
Airborne precautions - CORRECT ANSWERS-Initiate airborne precautions for a client
with anorexia, low-grade fever, night sweats, and productive cough, as these are
manifestations of tuberculosis.
TPN administration - CORRECT ANSWERS-Administer dextrose 10% in water until
new TPN bag arrives to avoid drop in blood glucose level.
Levothyroxine interaction - CORRECT ANSWERS-Instruct client to avoid taking calcium
within 4 hr of levothyroxine administration, as calcium can interfere with the
effectiveness of the medication.
Mechanical ventilation anxiety - CORRECT ANSWERS-Instruct client to allow the
machine to breathe for them to reduce anxiety and restlessness associated with fighting
the ventilator.
Adverse effect of enalapril - CORRECT ANSWERS-Identify orthostatic hypotension as
an adverse effect of enalapril.
Delayed wound healing - CORRECT ANSWERS-Identify urine output of 25 mL/hr as a
finding that contributes to delayed wound healing.
Hypothyroidism and opioid analgesic - CORRECT ANSWERS-Instruct client to void
every 4 hours to decrease the risk of urinary retention, which is an adverse effect of
opioid analgesics.
Portal hypertension - CORRECT ANSWERS-Obtain vital signs first when caring for a
client who is vomiting blood mixed with food after a meal, as this indicates a potential
rupture of esophageal varices.
Gastrectomy postoperative instructions - CORRECT ANSWERS-Instruct client to avoid
drinking fluids with meals, eat several small meals per day, consume high-protein
snacks, and avoid highly seasoned foods.
Cushing's triad - CORRECT ANSWERS-Identify bradycardia as a component of
Cushing's triad in a client with increased intracranial pressure from a traumatic brain
injury.
medication administration.
Postoperative lab values - CORRECT ANSWERS-Report Hgb level of 8 g/dL to
provider as an indicator of postoperative hemorrhage or anemia.
ESWL procedure - CORRECT ANSWERS-Expect stone fragments in the urine after
extracorporeal shock wave lithotripsy.
Airborne precautions - CORRECT ANSWERS-Initiate airborne precautions for a client
with anorexia, low-grade fever, night sweats, and productive cough, as these are
manifestations of tuberculosis.
TPN administration - CORRECT ANSWERS-Administer dextrose 10% in water until
new TPN bag arrives to avoid drop in blood glucose level.
Levothyroxine interaction - CORRECT ANSWERS-Instruct client to avoid taking calcium
within 4 hr of levothyroxine administration, as calcium can interfere with the
effectiveness of the medication.
Mechanical ventilation anxiety - CORRECT ANSWERS-Instruct client to allow the
machine to breathe for them to reduce anxiety and restlessness associated with fighting
the ventilator.
Adverse effect of enalapril - CORRECT ANSWERS-Identify orthostatic hypotension as
an adverse effect of enalapril.
Delayed wound healing - CORRECT ANSWERS-Identify urine output of 25 mL/hr as a
finding that contributes to delayed wound healing.
Hypothyroidism and opioid analgesic - CORRECT ANSWERS-Instruct client to void
every 4 hours to decrease the risk of urinary retention, which is an adverse effect of
opioid analgesics.
Portal hypertension - CORRECT ANSWERS-Obtain vital signs first when caring for a
client who is vomiting blood mixed with food after a meal, as this indicates a potential
rupture of esophageal varices.
Gastrectomy postoperative instructions - CORRECT ANSWERS-Instruct client to avoid
drinking fluids with meals, eat several small meals per day, consume high-protein
snacks, and avoid highly seasoned foods.
Cushing's triad - CORRECT ANSWERS-Identify bradycardia as a component of
Cushing's triad in a client with increased intracranial pressure from a traumatic brain
injury.
