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NEW QUESTION: 1
A 16-month-old infant is being prepared for tetralogy of Fallot repair. In the nursing assessment, which lab value should elicit further assessment and requires notification of physician?
A. Hematocrit 60%
B. pH 7.39
C. Bleeding time of 4 minutes
D. White blood cell (WBC) count 10,000 WBCs/mm3
Answer: A
Explanation:
Explanation
(A) Normal pH of arterial blood gases for an infant is 7.35-7.45. (B) Normal white blood cell count in an infant is 6,000-17,500 WBCs/mm3. (C) Normal hematocrit in infant is 28%-42%. A 60% hematocrit may indicate polycythemia, a common complication of cyanotic heart disease. (D) Normal bleeding time is 2-7 minutes.

NEW QUESTION: 2
A 74-year-old female client is 3 days postoperative. She has an indwelling catheter and has been progressing well. While the nurse is in the room, the client states, "Oh dear, I feel like I have to urinate again!" Which of the following is the most appropriate initial nursing response?
A. Ask her if she has felt this way before.
B. Check the collection bag and tubing to verify that the catheter is draining properly.
C. Assure her that this is most likely the result of bladder spasms.
D. Instruct her to do Kegel exercises to diminish the urge to void.
Answer: B
Explanation:
Explanation
(A) Although this may be an appropriate response, the initial response would be to assure the patency of the catheter. (B) The most frequent reason for an urge to void with an indwelling catheter is blocked tubing. This response would be the best initial response. (C) Kegel exercises while a retention catheter is in place would not help to prevent a voiding urge and could irritate the urethral sphincter. (D) Though the nurse would want to ascertain whether the client has felt the same urge to void before, the initial response should be to assure the patency of the catheter.

NEW QUESTION: 3

A. Option D
B. Option B
C. Option C
D. Option A
Answer: A