A nurse is caring for a client who is postoperative following a knee arthroscopy. Which of the following actions should the nurse take?
- A. Apply a warm compress to the surgical site.
- B. Elevate the client's leg.
- C. Encourage the client to bear weight immediately.
- D. Administer a stool softener daily.
Correct Answer: B
Rationale: Elevating the leg reduces swelling and promotes recovery. Warm compresses risk inflammation, early weight-bearing may harm, and stool softeners aren't routine.
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A nurse is caring for a client who is postoperative following a cesarean birth. Which of the following actions should the nurse take?
- A. Encourage the client to ambulate within 24 hr.
- B. Instruct the client to avoid coughing.
- C. Apply a cold pack to the incision site.
- D. Administer a laxative every 2 hr.
Correct Answer: A
Rationale: Ambulation within 24 hours prevents thromboembolism and aids recovery. Coughing supports lung function, cold packs aren't standard, and laxatives aren't given that frequently.
A nurse is caring for a client who is receiving continuous bladder irrigation following a transurethral resection of the prostate. Which of the following actions should the nurse take?
- A. Monitor the client's urine output every 4 hr.
- B. Irrigate the catheter with sterile water every 2 hr.
- C. Check the catheter tubing for blood clots.
- D. Administer an antibiotic prophylactically.
Correct Answer: C
Rationale: Checking for clots ensures catheter patency, critical for irrigation. Output monitoring is secondary, manual irrigation isn't routine, and antibiotics depend on orders.
A nurse is reinforcing teaching with a client who has a new prescription for fluoxetine. Which of the following statements should the nurse include?
- A. You should take this medication at bedtime.
- B. You might experience weight loss while taking this medication.
- C. You need to avoid tyramine-rich foods while taking this medication.
- D. You can expect symptom improvement within 24 hours.
Correct Answer: A
Rationale: Fluoxetine is often taken at bedtime to minimize daytime side effects like agitation. Weight changes vary, tyramine isn't a concern, and effects take weeks.
A nurse is assisting with preparing a client who is to have a central venous catheter inserted for the administration of total parenteral nutrition (TPN. Which of the following actions should the nurse take?
- A. Verify the amount of TPN solution the client is receiving every 4 hr.
- B. Prepare the client for a chest x-ray to verify catheter placement.
- C. Place the client in Sims' position for catheter insertion.
- D. Use a clean technique when changing the catheter dressing.
Correct Answer: B
Rationale: A chest X-ray confirms proper central venous catheter placement, critical for safe TPN administration. Verifying solution, Sims' position, or clean technique are inappropriate.
A nurse is reinforcing teaching with a client who has a new prescription for gabapentin. Which of the following statements should the nurse include?
- A. You should take this medication with a high-fat meal.
- B. You might feel drowsy while taking this medication.
- C. You need to avoid alcohol while taking this medication.
- D. You can stop taking this medication as soon as your symptoms improve.
Correct Answer: B
Rationale: Gabapentin can cause drowsiness, requiring caution. Food intake is flexible, alcohol avoidance is prudent but secondary, and abrupt stopping risks symptom recurrence.
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