A client is admitted with abdominal pain, loss of appetite, and a weight loss of 25 lb (11 kg) in the last four months. During the admission assessment, the client describes to the nurse of having no interest in playing cards with friends anymore and feels worthless most days. Which nursing problem should the nurse address first?

A. Have the client sign consent forms for procedures already performed: It is inappropriate to have the client sign consent forms for procedures that have already been completed. Consent must be obtained before procedures, and once a patient is awake, a retrospective consent is not legally valid.

B. Decrease the noise and light stimuli in the room as much as possible: As the client becomes more aware, it’s important to create a calm and quiet environment to reduce sensory overload. This helps the client adjust to the waking process and minimizes confusion or distress.

C. Consider extubating the client: Extubation should not be considered until the client is fully awake, alert, and able to maintain their own airway. The client is still recovering from the effects of anesthesia and requires ongoing monitoring before extubation can be safely considered.

D. Increase the propofol infusion: There is no indication that the propofol infusion needs to be increased, especially now that the client is waking up. The goal is to reduce sedation as the client becomes more aware, not increase it.

E. Determine the client's decision-making ability: As the client regains awareness, it’s crucial to assess her ability to make decisions. This will help guide the plan of care, particularly if she needs to provide consent for further procedures or treatment.

F. Explain all procedures: It’s important to explain any procedures and provide information about her care. This helps reduce anxiety, ensures the client understands what is happening, and promotes collaboration in the care process.

G. Notify the social worker the client is awake: The social worker should be notified as the client becomes more aware so they can assist with family contact and provide necessary emotional support.

H. Assess the client's pain: Assessing pain levels is crucial, especially given the trauma and the potential for post-operative discomfort. Ensuring pain is managed effectively will promote recovery and improve the patient's comfort.

A. Explain expected side effects of postoperative chemotherapy: Chemotherapy and its side effects are typically discussed after surgery when the treatment plan is clearer. The focus before surgery should be on preparing the child and family for the surgery itself.

B. Monitor blood pressure every 2 hours for hypertension: Wilm's tumor can be associated with hypertension due to renin production from the tumor, so monitoring the child's blood pressure closely is essential to detect any signs of hypertension early.

C. Provide parents with simple explanations and repeat often: Simplified, repeated explanations are key to helping parents understand the diagnosis and surgical procedure. This approach supports emotional comfort and ensures informed decision-making.

D. Attend all healthcare provider and parent conferences: While it is important to support the family, the nurse’s role in attending all healthcare provider and parent conferences is not mandatory unless specifically needed for continuity of care.

E. Measure the child's abdominal girth: Measuring abdominal girth is essential preoperatively to monitor for any abdominal changes, such as swelling or distension, which could indicate tumor growth or other complications related to the Wilm's tumor.