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21. A physician ordered Anthony, a male client who was admitted due to aspiration of gastric contents, to undergo decompression of the stomach. A nurse is tasked withinserting a nasogastric tube. As the nurse inserts the tube, resistance is met. Which of the following is the next action of the nurse?
22. A nurse is caring for Mrs. Thomas, an adult female who sustained second-to-third-degree burn injuries in the anterior and posterior thorax. A physician orders silver sulfadiazine during wound dressing. The nurse recognizes the client’s susceptibility to infection. Which of the following is the best action to prevent wound infection during cleaning and dressing?
23. A nurse is monitoring an 82-year-old male who had a transurethral resection of the prostate 12 hours ago. A three-way urinary catheter is inserted through the client’s urethra and into the bladder for continuous irrigation. A total of 3,000 mL of bladder irrigant has been infused for the past 8 hours. After assessing the client, the nurse immediately contacts the physician for a possible complication of the procedure. Which of the following is most likely noted by the nurse during the assessment?
24. A nurse is caring for Elaine, a 5-year-old child who was admitted due to a suspected case of brain tumor. Diagnostic tests reveal that the child has a brain tumor involving the cerebellum. A surgery is ordered. During the pre-operative period, which of the following is the most important nursing intervention for the client?
25. A nurse is assigned to the in-hospital triage area, which utilizes a three-tier system: emergent, urgent, and non-urgent. Which of the following clients has an emergent condition and needs to receive treatment immediately or within 15 to 30 minutes of admission?