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NO.1 A 5-year-old has just had a tonsillectomy and adenoidectomy. Which of these nursing measures
should be included in the postoperative care?
A. Observe for evidence of bleeding.
B. Encourage the child to cough up blood if present.
C. Have child gargle and do toothbrushing to remove old blood.
D. Give warm clear liquids when fully alert.
Answer: A

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Explanation:
(A) The nurse should discourage the child from coughing, clearing the throat, or putting objects in his
mouth. These may induce bleeding. (B) Cool, clear liquids may be given when child is fully alert.
Warm liquids may dislodge a blood clot. The nurse should avoid red- or brown-colored liquids to
distinguish fresh or old blood from ingested liquid should the child vomit. (C) Gargles and vigorous
toothbrushing could initiate bleeding. (D) Postoperative hemorrhage, though unusual, may occur.
The nurse should observe for bleeding by looking directly into the throat and for vomiting of bright
red blood, continuous swallowing, and changes in vital signs.

NO.2 A client has been taking lithium 300 mg po bid for the past two weeks. This morning her
lithium level was 1 mEq/L. The nurse should:
A. Notify the physician immediately
B. Hold the morning lithium dose and continue to observe the client
C. Obtain an order for benztropine (Cogentin)
D. Administer the morning lithium dose as scheduled
Answer: D

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Explanation:
(A) There is no need to phone the physician because the lithium level is within therapeutic range and
because there are no indications of toxicity present. (B) There is no reason to withhold the lithium
because the blood level is within therapeutic range. Also, it is necessary to give the medication as
scheduled to maintain adequate blood levels. (C) The lab results indicate that the client's lithium level
is within therapeutic range (0.2-1.4 mEq/L), so the medication should be given as ordered. (D)
Benztropine is an antiparkinsonism drug frequently given to counteractextrapyramidal symptoms
associated with the administration of antipsychotic drugs (not lithium).

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