A client diagnosed with cholecystitis reports right upper quadrant pain that radiates to the right shoulder. Which of the following interventions is the priority for the nurse to implement?

Choice A Reason: This is incorrect because submerging the client in a cold bath can cause hypothermia, shock, or infection. Cold water can lower the body temperature and blood pressure, which can impair circulation and organ function. Cold water can also introduce bacteria or contaminants into the open wounds. The nurse should use cool water or saline to gently irrigate the burned areas and then cover them with sterile dressings.

Choice B Reason: This is correct because administering oxygen can help the client breathe better and prevent hypoxia. Burns to the face, neck, or chest can cause swelling or damage to the airway, which can impair gas exchange and oxygen delivery. Oxygen can also reduce the risk of carbon monoxide poisoning, which can occur from inhaling smoke or fumes.

Choice C Reason: This is incorrect because restricting fluids can worsen dehydration and shock. Burns can cause significant fluid and electrolyte loss through evaporation and leakage from damaged capillaries. This can lead to hypovolemia, which is low blood volume, and hypotension, which is low blood pressure. The nurse should monitor the client's vital signs, urine output, and weight, and administer intravenous fluids as ordered.

Choice D Reason: This is incorrect because providing a meal high in fiber can cause abdominal discomfort or diarrhea. Burns can cause paralytic ileus, which is a temporary loss of bowel function due to nerve damage or inflammation. This can impair digestion and absorption of food and cause nausea, vomiting, or constipation. The nurse should assess the client's bowel sounds and provide enteral or parenteral nutrition as ordered.

Choice E Reason: This is correct because assessing airway is a priority nursing action for a client with burns. As mentioned above, burns to the face, neck, or chest can compromise the airway and cause respiratory distress or failure. The nurse should assess the client's level of consciousness, breathing rate and pattern, oxygen saturation, and signs of inhalation injury, such as sooty sputum, singed nasal hairs, or hoarseness. The nurse should also be prepared to assist with intubation or tracheostomy if needed.

Choice F Reason: This is correct because applying ice to burned areas can help reduce pain and swelling. Ice can constrict blood vessels and numb nerve endings, which can decrease inflammation and sensation. However, ice should be applied for no more than 15 minutes at a time and wrapped in a cloth or towel to prevent frostbite or tissue damage. Ice should not be applied to large or deep burns.

Choice A reason: This is incorrect because loss of peripheral vision is not a manifestation of cataracts, but of glaucoma. Glaucoma is a condition that causes increased pressure inside the eye and damage to the optic nerve, which can lead to loss of vision in the outer edges of the visual field. The nurse should assess the client's intraocular pressure and visual field test results to rule out glaucoma.
Choice B reason: This is correct because a decreased ability to perceive colors is a manifestation of cataracts. Cataracts are a condition that causes clouding or opacity of the lens, which is the transparent structure behind the pupil that focuses light onto the retina. Cataracts can reduce the clarity and contrast of vision and make colors appear faded or yellowish. The nurse should ask the client about any changes in color perception or brightness of objects.
Choice C reason: This is incorrect because loss of central vision is not a manifestation of cataracts but of macular degeneration. Macular degeneration is a condition that affects the macula, which is the central part of the retina that is responsible for sharp and detailed vision. Macular degeneration can cause blurred or distorted central vision, difficulty reading or recognizing faces, or dark spots in the visual field. The nurse should assess the client's visual acuity and fundoscopic examination results to rule out macular degeneration.
Choice D reason: This is incorrect because seeing bright flashes of light and floaters is not a manifestation of cataracts but of retinal detachment. Retinal detachment is a condition that occurs when the retina, which is the layer of tissue at the back of the eye that converts light into nerve impulses, separates from its underlying support tissue. Retinal detachment can cause sudden flashes of light, floaters, or shadows in the visual field. The nurse should refer the client to an ophthalmologist immediately if retinal detachment is suspected.