Nokea
The nurse is caring for a woman who just delivered a healthy baby. She received a saddle block anesthesia during delivery. She is admitted to the postpartum unit. Which nursing action is most appropriate?
- A. Encourage her to ambulate as soon as sensation and motion have returned.
- B. Keep her flat and quiet for eight hours.
- C. Keep her NPO for four hours.
- D. Position her in a semi-sitting position as soon as she is alert.
Correct Answer: B
Rationale: Saddle block (spinal) anesthesia requires the client to remain flat for 8 hours to prevent spinal headache due to cerebrospinal fluid loss.
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A young man had an emergency appendectomy for a ruptured appendix. He is in the postanesthesia care unit. He has not yet awakened. An IV is running. A Penrose drain is in place. How should the nurse position this client?
- A. Semi-sitting position
- B. Supine with head turned to the side
- C. Prone with head and neck extended
- D. Right Sims' position
Correct Answer: B
Rationale: Positioning supine with the head turned to the side prevents aspiration in an unconscious client, maintaining airway safety.
A 19-year-old unmarried college student is admitted unconscious following a car accident. He is hemorrhaging from severe internal injuries. Which statement is true concerning obtaining informed consent for treating him?
- A. Emergency care can be given because his injuries are life threatening.
- B. He can sign his own consent form because he is older than 18.
- C. Parental consent must be obtained before treatment is started.
- D. The hospital must obtain a court order before treating him.
Correct Answer: A
Rationale: In life-threatening emergencies, treatment can proceed without consent under implied consent, as the unconscious patient cannot provide consent and delay could be fatal.
Preoperative orders for an adult client include pentobarbital. The nurse knows that this drug is administered primarily to:
- A. control secretions.
- B. control pain.
- C. promote sedation.
- D. provide anesthesia.
Correct Answer: C
Rationale: Pentobarbital, a barbiturate, is used preoperatively to promote sedation, calming the client before surgery.