Exam (elaborations) Lewis medical surgical nursing 11th

Urinary output of 20mL/hr answer- The nurse has just reassessed the condition of a postoperative client who was admitted 1 hour ago to the surgical unit. The nurse plans to monitor which parameter MOST carefully during the next hour? A. Urinary output of 20ml/hr B. Temperature of 37.6 C (99.6 F) C. Blood Pressure of 100/70 mmHg D. Serous drainage on the surgical dressing A. Use of an incentive spirometer will help prevent pneumonia answer- The nurse is teaching a client about coughing and deep-breathing techniques to prevent postoperative complications. Which statement is MOST APPROPRIATE for the nurse to make to the client at this time as it relates to these techniques? A. Use of an incentive spirometer will help prevent pneumonia B. Close monitoring of your oxygen saturation will detect hypoxemia C. Administration of intravenous fluids will prevent or treat fluid imbalance D. Early ambulation and administration of blood thinners will prevent pulmonary embolism C. have the client void immediately before going into surgery answer- The nurse is creating a plan of care for a client scheduled for surgery. The nurse should include which activity in the nursing care plan for the client on the day of Surgery? A. avoid oral hygiene and rinsing with mouthwash B. verify that the client has not eaten for the last 24 hrs C. have the client void immediately before going into surgery D. Report immediately any slight increase in blood pressure or pulse D. obtain a telephone consent from a family memeber following agency policy answer- A client with a gastric ulcer is scheduled for surgery. The client cannot sign the operative consent form because of sedation from opioid analgesics that have been administered. The nurse should take which MOST APPROPRIATE action in the care of this client? A. Obtain a court order for the surgery B. Have the charge nurse sign the informed consent immediately C. Send the client to surgery without the consent being signed D. Obtain a telephone consent from a family member, following agency policy.