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    HESI RN Exit Proctored ExamQuestion 32
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    HESI RN Exit Proctored Exam

    The nurse is admitting a client from the postanesthesia care unit (PACU) to the postoperative surgical care unit. Which prescription should the nurse implement first?

    Explanation & Rationale

    A. Advancing to clear liquids is important for nutritional support but is secondary to ensuring urinary function is restored. B. Urinary retention is a concern after anesthesia, but it is not an immediate threat. This intervention is conditional (“if unable to void”), meaning it is implemented only if needed. C. Postoperative clients are at high risk for infection. Cefazolin (a broad-spectrum antibiotic) is a prophylactic measure to reduce the risk of surgical site infection, which is a priority intervention immediately after surgery. This should be implemented first, since infection prevention begins as soon as the client arrives from PACU. D. A CBC is important for monitoring but is not urgent in comparison to immediate care needs like urinary output.

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