a child returns from exploratory surgery following a gunshot wound to the abdomen which nursing intervention should be excluded for the plan of care a child returns from exploratory surgery following a gunshot wound to the abdomen which nursing intervention should be excluded for the plan of care
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Nursing Elites

ATI RN

ATI Pediatric Proctored Exam

1. Following a child's return from exploratory surgery due to a gunshot wound to the abdomen, which nursing intervention should be excluded from the plan of care?

Correct answer: A

Rationale: Immediate initiation of oral feedings should be excluded from the plan of care post-abdominal surgery due to the risk of bowel complications like paralytic ileus or anastomotic leak. Starting oral feedings immediately can increase these risks and hinder healing. It is crucial to wait until bowel function returns and the patient shows signs of tolerance before introducing oral feedings. Assessment of the surgical site is necessary to monitor for any signs of infection or complications. Administration of opioid narcotics for pain management is essential for ensuring the patient's comfort post-surgery. Visitation at the bedside provides emotional support and can aid in the patient's recovery. Therefore, the correct answer is to exclude immediate initiation of oral feedings.

2. A client is prescribed Clopidogrel. Which of the following laboratory values should be monitored to assess for potential adverse effects?

Correct answer: B

Rationale: Clopidogrel is an antiplatelet medication, so monitoring the client's platelet count is crucial to assess for potential bleeding complications. Changes in platelet count can indicate an increased risk of bleeding, a known adverse effect of Clopidogrel. Monitoring white blood cell count, hemoglobin, or blood glucose is not directly related to the potential adverse effects of Clopidogrel and would not provide relevant information regarding the medication's impact on platelet function.

3. A nurse is caring for a client who has chronic pancreatitis. Which of the following dietary recommendations should the nurse make?

Correct answer: C

Rationale: The correct answer is C: Broiled skinless chicken breast with brown rice. This option is suitable for a client with chronic pancreatitis as it is a low-fat, high-protein meal. Clients with pancreatitis should avoid high-fat foods like creamer, margarine, and avocados, making options A, B, and D incorrect choices.

4. If a gastric acid perforates, which of the following actions should not be included in the immediate management of the client?

Correct answer: B

Rationale: Antacid administration should not be included in the immediate management of a gastric perforation.

5. Which of the following processes does not help maintain the life of an individual organism?

Correct answer: C: Reproduction

Rationale: Reproduction is the correct answer because it is not essential for maintaining the life of an individual organism. While reproduction is crucial for the continuation of a species, it is not directly related to the survival or maintenance of an individual organism. Responsiveness allows an organism to react to stimuli, movement helps in obtaining resources and avoiding danger, and respiration provides the necessary energy for life processes. Therefore, reproduction is the process that does not directly contribute to maintaining the life of an individual organism.

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