A client with pancreatitis complains of severe epigastric pain, so the nurse administers a prescribed narcotic analgesic. Ten minutes later, the client insists on sitting up and leaning forward. Which intervention should the nurse implement?
Encourage rest until the analgesic becomes effective.
Raise head of bed until at a 90 degree angle.
Place bed in a reverse Trendelenburg position.
Position bedside table so the client can lean across it.
The Correct Answer is D
Choice A: Encourage rest until the analgesic becomes effective. This is not the best intervention, as it does not address the client's preference or comfort level. The analgesic may take some time to relieve the pain, and forcing the client to lie down may increase the pressure on the pancreas and worsen the pain.
Choice B: Raise head of bed until at a 90 degree angle. This is not the best intervention, as it does not address the client's preference or comfort level. Raising the head of bed may help reduce abdominal distension and improve breathing, but it may not relieve the pain as much as leaning forward.
Choice C: Place bed in a reverse Trendelenburg position. This is not the best intervention, as it does not address the client's preference or comfort level. Placing the bed in a reverse Trendelenburg position may help shift the abdominal organs away from the pancreas and reduce inflammation, but it may not relieve the pain as much as leaning forward.
Choice D: Position bedside table so the client can lean across it. This is the best intervention, as it addresses the client's preference and comfort level. Leaning forward may help decrease the tension on the pancreas and relieve the pain. The bedside table can provide support and stability for the client while sitting up.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A: Assessing pupillary response to light hourly is not an intervention that the nurse should implement while administering dopamine, as this is not related to the effects or side effects of dopamine. This is a distractor choice.
Choice B: Initiating seizure precautions is not an intervention that the nurse should implement while administering dopamine, as this is not a common or expected complication of dopamine. This is another distractor choice.
Choice C: Monitoring serum potassium frequently is not an intervention that the nurse should implement while administering dopamine, as this is not affected by dopamine or hypotension. This is another distractor choice.
Choice D: Measuring urinary output every hour is an intervention that the nurse should implement while administering dopamine, as this can indicate the effectiveness of dopamine in improving renal perfusion and blood pressure. Therefore, this is the correct choice.
Correct Answer is D
Explanation
Choice A: Increasing oxygen to 6 liters/minute is not an intervention that the nurse should implement, as this can worsen bronchospasm and hypoxia by reducing the hypoxic drive and causing carbon dioxide retention. This is a contraindicated choice.
Choice B: Calling for an Ambu resuscitation bag is not an intervention that the nurse should implement, as this is not indicated for a client who is conscious and breathing spontaneously. This is an overreaction choice.
Choice C: Instructing the client to lie back in bed is not an intervention that the nurse should implement, as this can increase respiratory distress and compromise airway clearance by reducing lung expansion and increasing abdominal pressure. This is another contraindicated choice.
Choice D: Administering a nebulizer treatment is an intervention that the nurse should implement, as this can deliver bronchodilators and anti-inflammatory agents directly to the airways and improve ventilation and oxygenation for this client. Therefore, this is the correct choice.
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