the nurse is caring for a client on the first postoperative day following a surgical repair of an abdominal aortic aneurysm which nursing diagnosis is the nurse is caring for a client on the first postoperative day following a surgical repair of an abdominal aortic aneurysm which nursing diagnosis is
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Nursing Elites

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Gastrointestinal System Nursing Exam Questions

1. The nurse is caring for a client on the first postoperative day following a surgical repair of an abdominal aortic aneurysm. Which nursing diagnosis is the most important for this client?

Correct answer: C

Rationale: Peripheral tissue perfusion is a major concern in the postoperative period following an abdominal aneurysm repair. Peripheral pulses should be checked frequently during the first 24 hours. A weak or absent pulse may be a sign of embolization or graft closure, especially if accompanied by a pale, cold, mottled extremity; the nurse should immediately report this to the surgeon. Risk for infection, deficient knowledge, and activity intolerance are all important nursing diagnoses in the postoperative period, but peripheral tissue perfusion is the most immediate concern.

2. What is the most effective way to prevent sudden infant death syndrome (SIDS)?

Correct answer: B

Rationale: The correct answer is to place the baby on their back to sleep. This position is the most effective way to prevent sudden infant death syndrome (SIDS) according to research and recommendations from healthcare providers. Choice A, using a firm mattress, is important for infant safety but not as directly related to preventing SIDS. Keeping the room warm, as mentioned in choice C, is not recommended as it may increase the risk of SIDS. While breastfeeding has many benefits, choice D, breastfeeding exclusively is not the most effective method for preventing SIDS.

3. What is the best nursing intervention for a patient experiencing fluid overload?

Correct answer: A

Rationale: The best nursing intervention for a patient experiencing fluid overload is to administer diuretics. Diuretics help the body to remove excess fluid by increasing urine output. This intervention is crucial in managing fluid overload. Administering IV fluids (Choice B) would worsen the condition by adding more fluids to the already overloaded system. Providing oral fluids (Choice C) is not appropriate as it would further contribute to the fluid overload. Chest physiotherapy (Choice D) is not indicated in the treatment of fluid overload and would not address the underlying issue of excess fluid accumulation.

4. An influenza outbreak has spread through a long-term care residence, affecting many of the residents with severe malaise, fever, and nausea and vomiting. In an effort to curb the outbreak, the nurse has liaised with a physician to see if residents may be candidates for treatment with what drug?

Correct answer: B

Rationale: The correct answer is B: Oseltamivir phosphate. Oseltamivir is an antiviral medication used to treat influenza infections. It works by inhibiting the neuraminidase enzyme of the influenza virus, reducing the spread of the virus in the body. Saquinavir mesylate (choice A) is used in the treatment of HIV, not influenza. Lamivudine (choice C) is also an antiviral medication primarily used in the treatment of HIV and hepatitis B, not influenza. Ribavirin (choice D) is used to treat certain viral infections like hepatitis C, respiratory syncytial virus (RSV), and some viral hemorrhagic fevers, but it is not a first-line treatment for influenza.

5. Although Justin spent his first 18 months in an orphanage, his adoptive mother believes that sensitive caregiving will help Justin overcome his early experiences. Justin's mother emphasizes the role of __________ in development.

Correct answer: A

Rationale: The correct answer is A, nurture. Nurture refers to the environmental influences that shape behavior and development. In this scenario, Justin's adoptive mother believes that providing sensitive caregiving will override the negative effects of his early experiences in the orphanage, highlighting the importance of nurture in promoting healthy development. Choice B, stages, is incorrect as it refers to the sequence of developmental milestones individuals pass through. Choice C, stability, is incorrect as it pertains to the consistency of behavior or development over time. Choice D, nature, is incorrect as it relates to genetic and biological factors influencing development, which is not the focus of Justin's mother's beliefs.

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