A patient who is just waking up after having hip replacement ...

[bobypop]

A patient who is just waking up after having hip replacement surgery is agitated and confused. Which action should the nurse take first?
 
  a. Administer the ordered opioid.
  b. Check the oxygen (O2) saturation.
  c. Take the blood pressure and pulse.
  d. Apply wrist restraints to secure IV lines.

Question 2

A patient is transferred from the postanesthesia care unit (PACU) to the clinical unit. Which action by the nurse on the clinical unit should be performed first?
 
  a. Assess the patient's pain.
  b. Orient the patient to the unit.
  c. Take the patient's vital signs.
  d. Read the postoperative orders.

[lorealeza]

Answer to Question 1

ANS: B
Emergence delirium may be caused by a variety of factors. However, the nurse should first assess for hypoxemia. The other actions also may be appropriate, but are not the best initial action.

Answer to Question 2

ANS: C
Because the priority concerns after surgery are airway, breathing, and circulation, the vital signs are assessed first. The other actions should take place after the vital signs are obtained and compared with the vital signs before transfer.

[bobypop]

Thanks for the timely response, appreciate it

[matt95]

Excellent