A nurse is caring for a client who has expressive aphasia. Which of the following techniques should the nurse use to meet the communication needs of this client?

Target 1: Paralytic ileus

• The client is 6 hours postoperative with hypoactive bowel sounds and no mention of flatus or stool. The use of IV opioids (morphine) increases the risk for reduced gastrointestinal motility. Paralytic ileus is common after abdominal surgery and with opioid use.

Target 2: Atelectasis

• The client has shallow bilateral breath sounds postoperatively, which indicates a risk for atelectasis, a common complication due to decreased mobility, pain limiting deep breathing, and effects of anesthesia.

Rationale for Incorrect Choices:

• Urinary tract infection: The client voided 350 mL of clear yellow urine after catheter removal with no signs of infection.
• Delayed wound healing: No signs of infection or poor wound healing; the dressing is dry and intact.
• Deep vein thrombosis: Though a risk postoperatively, the client is wearing SCDs and has even pedal pulses with no edema, lowering immediate concern.

A. Locks the wheelchair after transferring the client: Locking the wheelchair should occur before the transfer to prevent it from rolling during the movement. Locking it after transferring compromises client safety and increases the risk of falls or injury.

B. Places the bed in a high position before transferring the client to the wheelchair: The bed should be placed in the lowest safe position to allow the client’s feet to touch the floor and to ease the transition to a lower surface like a wheelchair. A high bed position creates an unsafe height differential.

C. Uses a narrow stance when assisting the client to the wheelchair: A wide stance provides a stronger, more stable base of support, which is essential for safe body mechanics during a transfer. A narrow stance can lead to imbalance and injury to the AP or client.

D. Positions the wheelchair parallel to the client's bed: Positioning the wheelchair parallel or at a slight angle to the bed allows for easier and safer transfers. This minimizes turning and supports a smoother pivot, reducing strain on both the client and caregiver.