NCLEX-RN

Category - Care Management

Rick Rescue, RN is working in the Emergency Department. He has just administered an analgesic to a client admitted for severe right upper-quadrant pain, nausea, and vomiting. The client’s abdominal x-ray and ultrasound indicate an enlarged gallbladder. The physician has informed the client of his recommendation for a cholecystectomy. The client has consented and is awaiting surgery. Which of the following is Rick Rescue, RN’s next priority for this client?
  1. Discussing dietary habits with client, to assess need for dietary teaching.
  2. Review health history for allergies.
  3. Discussing client’s support system, to assess need for discharge planning.
  4. Assess fluid/electrolyte status.
Explanation
Answer: D - Hypokalemia and hypomagnesemia are common in acute cholecystitis. Either can present a life-threatening event. It is for this reason that assessing the client’s fluid and electrolyte status is the highest priority.
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