A nurse is caring for a client.

Exhibit 1 Nurses' Notes Day 1: Exhibit 2 Exhibit 3 Client reports fatigue, weight loss, night sweats, and a persistent cough.

Performed a purified protein derivative test on the client and obtained a QuantiFERON-TB Gold blood test as prescribed.

Bilateral breath sounds with crackles and scattered wheezes throughout.

Cough productive for yellow, purulent sputum.

What are the first two actions the nurse should take?

Answer: The correct answer is choice c. Ensure the client is free of metal objects.

Here's the rationale for each choice:

• Choice A: Rationale: Bowel cleansing is not routinely performed before an intravenous pyelogram (IVP) unless there is a specific concern about fecal matter obscuring the urinary tract on the X-rays.
• Choice B: Rationale: While pain in the suprapubic region (lower abdomen) is not a common side effect of an IVP, the nurse should be aware of this possibility and assess the client for any discomfort. However, monitoring for pain is not a specific action to include in preparation for the procedure.
• Choice C: Rationale: Metal objects can interfere with the X-ray images during an IVP. Ensuring the client removes any jewelry or clothing with metal fasteners is an important step in preparation.
• Choice D: Rationale: Oral contrast is not typically used in an IVP. The contrast material for this procedure is administered intravenously.

The nurse’s entry “New dressing applied as prescribed; no drainage on old dressing” demonstrates correct documentation because it includes specific details about the wound and the dressing change.
Choice A is wrong because it does not provide specific details about the wound or the dressing change.
Choice C is wrong because it includes subjective language (“seems” and “does not appear”) rather than objective observations.
Choice D is wrong because it only documents medication administration and does not provide any information about the wound or the dressing change.