A nurse is caring for a client who is 24 hr postoperative following abdominal surgery. The client received an opioid analgesic 1 hr ago and now reports a pain level of 2 on a scale of 0 to 10. Which of the following actions should the nurse take?
Maintain the client on bed rest.
Apply a warm, moist compress to the incision area.
Administer an additional dose of pain medication.
Reposition the client.
The Correct Answer is D
Answer is: d. Reposition the client.
Explanation: Repositioning the client can help alleviate pain by redistributing pressure and promoting comfort. Since the client's pain level is relatively low (2 on a scale of 0 to 10), this non-pharmacological intervention is an appropriate initial action.
Choice a. is wrong because maintaining the client on bed rest is not an appropriate action for a pain level of 2. Instead, the nurse should encourage the client to mobilize and perform appropriate exercises to prevent complications related to immobility.
Choice b. is wrong because applying a warm, moist compress to the incision area might not be the best action for a client who is 24 hours postoperative, as it could increase the risk of infection and cause discomfort. Cold compresses are often used in the initial postoperative period to reduce swelling and promote comfort.
Choice c. is wrong because administering an additional dose of pain medication is not necessary at this point, as the client's pain level is relatively low. The nurse should consider non-pharmacological interventions first and reassess the client's pain level to determine the need for further pain relief.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The client should wear a mask during transport to prevent the spread of infectious droplets. The nurse should wear appropriate personal protective equipment (PPE) based on the precautions required for the specific client, which in this case would be a mask. The nurse does not need to wear a gown as droplet precautions do not require the use of a gown during transport.
The correct answer is choice C, the client should wear a mask during transport.
Choice A rationale:
The client wearing a gown during transport is not typically necessary for droplet precautions unless there is a risk of the gown becoming contaminated with infectious material. Gowns are primarily used to protect the healthcare worker or other patients if there is direct contact with the patient.
Choice B rationale:
While the nurse should wear a mask if they will be within close proximity to the client, the primary concern in droplet precautions is to prevent the spread of infection from the client, who is the source of the droplets.
Choice C rationale:
The client should wear a mask during transport to contain respiratory secretions and minimize the risk of droplet spread, as droplets can be disseminated by coughing, sneezing, or talking. This is a key component of source control in droplet precautions.
Choice D rationale:
Similar to choice A, the nurse wearing a gown during transport is not a standard requirement for droplet precautions unless there is anticipated contact with the patient or their environment that might result in contamination.
In summary, the primary goal of droplet precautions is to prevent the spread of infections through large respiratory droplets that are expelled by the client. Therefore, having the client wear a mask is the most effective measure among the options provided to reduce the risk of transmission during transport.
Correct Answer is A
Explanation
The correct answer is choice A. Washing hands after leaving the room is an important infection control measure for individuals who come into contact with clients on contact precautions. Choice B is incorrect because gowns are only necessary when there is a risk of contact with the client's body fluids. Choice C is incorrect because gloves should not be reused. Choice D is incorrect because the client should not leave the room while on contact precautions. Choice B is not correct because gowns are only necessary when there is a risk of contact with the client's body fluids. Choice C is not correct because gloves should not be reused. Choice D is not correct because the client should not leave the room while on contact precautions.
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