A nurse is caring for a client who is 2 days postoperative from abdominal surgery. The client reports discomfort from abdominal distension and flatus. Which of the following suggestions should the nurse include?

Assume position with legs and rectum lower than the stomach.

Drink cold liquids.

Ambulate several times a day.

Use a straw.

Answer and Explanation

The Correct Answer is C

A. Assume position with legs and rectum lower than the stomach.

Explanation: This position helps gas move through the intestines more effectively, relieving abdominal distension and promoting the passage of flatus. It's a commonly recommended position for patients experiencing discomfort due to abdominal gas.
B. Drink cold liquids.

Explanation: Drinking cold liquids might not directly help with abdominal distension and flatus. Warm liquids, on the other hand, can sometimes promote digestion and relieve gas discomfort.
C. Ambulate several times a day.

Explanation: Ambulation or walking encourages movement in the intestines, aiding in the passage of gas. It also promotes overall bowel function and can help prevent postoperative complications like atelectasis and deep vein thrombosis.
D. Use a straw.

Explanation: Using a straw doesn't have a direct impact on relieving abdominal distension or flatus. It's more relevant for patients who might have difficulty drinking directly from a glass due to medical conditions or after certain types of surgeries

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Correct Answer is C

Explanation

A. Keep the head of the bed elevated at 15 degrees.

This is not sufficient for preventing aspiration and ensuring proper digestion. The head of the bed should be elevated at least 30 degrees to reduce the risk of aspiration and promote better digestion of enteral feedings.

B. Place enough formula in the feeding bag to last for 8 hr of continuous feeding: It is recommended to change the feeding formula and bag every 24 hours. Placing formula for an extended period can increase the risk of bacterial growth.

C. Flush the tube with 30 ml of water every 4 hr: Regular flushing of the tube helps maintain patency, prevents clogging, and ensures proper hydration. Flushing every 4 hours is a standard practice for continuous feeding.

D. Change the feeding bag and tubing every 72 hr: Feeding bags and tubing should be changed more frequently, typically every 24 hours, to reduce the risk of infection.

A. Obtain the client's vital signs. B. Weigh the client. C. Change the client's dressing. D. Administer pain medication.

Correct Answer is D

Explanation

A. Obtain the client's vital signs:
Vital signs are essential for assessing the client's overall condition and can provide crucial information about the client's stability. However, in this scenario, there's a higher priority nursing action that needs immediate attention.

B. Weigh the client:
Daily weight measurement is important, especially in postoperative patients, to monitor for fluid retention or loss. However, this is not the most urgent action in this situation.

C. Change the client's dressing:
Changing the dressing involves maintaining the surgical site's cleanliness and preventing infections. While this is important, it's not the highest priority in this situation.

D. Administer pain medication:
Correct Choice. Addressing the client's pain is a priority to ensure their comfort and well-being, especially postoperatively. Managing pain effectively is crucial for the client's recovery and can facilitate other necessary activities, such as changing the dressing or weighing the client.

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A nurse is caring for a client who is 2 days postoperative from abdominal surgery. The client reports discomfort from abdominal distension and flatus. Which of the following suggestions should the nurse include?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

Correct Answer is D

Explanation

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