A nurse is caring for a postoperative patient.
When helping to manage the patient’s pain, which of the following principles should the nurse apply? (Select all that apply)

Expect the patient to express his pain both verbally and nonverbally

Administer opioids with caution because they will eventually lead to addiction

Consider the patient’s individual expression of pain

Use a scale from 0 to 10 to monitor the severity of the patient’s pain

Answer and Explanation

Correct Answer : A,C,D

Choice A rationale

Pain is a subjective experience and can be expressed both verbally and nonverbally. It is important for the nurse to be attentive to both types of expressions to effectively manage the patient’s pain.
Choice B rationale
While it is true that opioids should be used with caution due to the risk of addiction, this statement can be misleading. Opioids are often necessary for managing postoperative pain, and the risk of addiction is low when they are used appropriately and under medical supervision.
Choice C rationale
Considering the patient’s individual expression of pain is crucial in pain management. Pain is a subjective experience and can vary greatly between individuals. Tailoring pain management strategies to the individual patient can improve pain control.
Choice D rationale
Using a pain scale is a common and effective way to monitor the severity of a patient’s pain. It provides a quantifiable measure of pain that can be used to guide treatment decisions.

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Correct Answer is B

Explanation

Choice A rationale
While intestinal obstruction can occur after any abdominal surgery, it is not the most common complication following ileostomy creation.
Choice B rationale
Fluid and electrolyte imbalance is a common complication following ileostomy surgery. This is due to the fact that the ileum, which is now rerouted to an external opening in the abdominal wall, is responsible for absorbing a significant amount of fluid and electrolytes. When it is diverted, these substances can be lost, leading to imbalances.
Choice C rationale
Malabsorption of fat is not typically a primary concern following ileostomy surgery. While malabsorption can occur in diseases affecting the ileum, it is not a direct result of the surgery itself.
Choice D rationale
Folate deficiency is not a common complication following ileostomy surgery. The terminal ileum, which is typically used to create the ileostomy, is primarily responsible for the absorption of vitamin B12, not folate.

A. “Before the procedure, you’ll need to remove any dentures.”. B. “After the procedure, you may have a sore throat for which you can use warm gargles or ice.”. C. “This test will allow the doctor to see directly into your esophagus, stomach, and part of your small intestine.”. D. “After the procedure, you can have something to drink after your gag reflex returns.”.

Correct Answer is D

Explanation

Choice A rationale
While it’s true that dentures and other oral appliances should be removed before an EGD to prevent damage or loss during the procedure, this information is not the most crucial for the patient to understand.
Choice B rationale
Although a sore throat can occur after an EGD due to the passage of the endoscope, it’s not the most important information. The patient should be aware that the sore throat is temporary and can be relieved with warm gargles or ice.
Choice C rationale

This choice is accurate. An EGD allows the doctor to directly visualize the esophagus, stomach, and part of the small intestine. However, this information, while important, is not the most critical aspect for the patient to understand about the post-procedure period.
Choice D rationale
This is the correct answer. After an EGD, it’s crucial for the patient to understand that they should not eat or drink until their gag reflex has returned. This is to prevent aspiration, which can occur if the patient tries to swallow food or liquid before the gag reflex is functioning properly.

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A nurse is caring for a postoperative patient. When helping to manage the patient’s pain, which of the following principles should the nurse apply? (Select all that apply)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient with Crohn’s disease has recently undergone surgery to create an ileostomy. For which common complication of this type of surgery should the nurse monitor the patient in the postoperative period?

Correct Answer is B

Explanation

After a diagnostic work-up, a 56-year-old male client was diagnosed with a duodenal ulcer caused by Helicobacter pylori infection. After treatment, the client is to have an esophagogastroduodenoscopy (EGD). Which teaching should the nurse reinforce?

Correct Answer is D

Explanation

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A nurse is caring for a postoperative patient.
When helping to manage the patient’s pain, which of the following principles should the nurse apply? (Select all that apply)