A Nurse Is Caring for a Patient in the Immediate

question 2

Multiple Choice

A nurse is caring for a patient in the immediate postoperative period after surgery in which a spinal anesthetic was used. The patient has not voided and complains of headache. The patient has a pulse of 62 beats/min, a respiratory rate of 16 breaths per minute, and a blood pressure of 92/48 mm Hg. Which action by the nurse is appropriate?

• A) Contact the anesthetist to request an order for ephedrine.
• B) Have the patient sit up to relieve the headache pain.
• C) Lower the head of the bed to a 10- to 15-degree head-down position.
• D) Obtain an order for a urinary catheter for urinary retention.

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Definitions:

Haloperidol

An antipsychotic medication used to treat schizophrenia, acute psychosis, and to control tics and vocal utterances of Tourette's syndrome.

Tardive Dyskinesia

A neurological disorder resulting in involuntary, repetitive body movements due to long-term antipsychotic medication use.

Idea of Reference

The false belief that casual incidents and external events have a particular and significant personal meaning, often seen in psychotic disorders.

Schizophrenia

A chronic brain disorder characterized by distorted thinking, perceptions, emotions, language, sense of self, and behavior.