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 it’s important to ensure the feeding bag contains enough formula for the feeding period, it’s not recommended to fill the bag with more than 4-6 hours’ worth of formula at a time due to the risk of bacterial growth.
Choice B rationale
This is the correct answer. Flushing the gastrostomy tube with water every 4 hours helps maintain tube patency and hydrates the patient.
Choice C rationale
Changing the feeding bag and tubing every 72 hours is a common practice, but it’s not the most critical intervention in this scenario.
Choice D rationale
Keeping the head of the bed elevated at 30 to 45 degrees during feeding and for 1 to 2 hours afterward is recommended to minimize the risk of aspiration. However, 15 degrees may not be sufficient.

A. Strawberry yogurt B. Chicken broth C. Apple juice D. Iced tea

Correct Answer is A

Explanation

Choice A rationale
After a Roux-en-Y surgical procedure, patients are typically put on a liquid-only diet for the first week or two after surgery. Over the next month, they are able to add soft food and eventually regular food back into their diet. Given that the patient is only one day postoperative, the consumption of solid foods like strawberry yogurt could potentially lead to

complications such as dumping syndrome, which is a group of symptoms that includes vomiting, nausea, and dizziness. It occurs when food moves from your stomach into your small intestine too quickly.
Choice B rationale
Chicken broth is a clear liquid and is generally considered safe for a patient who is one day postoperative from a Roux-en-Y surgical procedure. It is easily digestible and does not put undue stress on the digestive system.
Choice C rationale
Apple juice is a clear liquid and is generally considered safe for a patient who is one day postoperative from a Roux-en-Y surgical procedure. It is easily digestible and does not put undue stress on the digestive system.
Choice D rationale
Iced tea is a clear liquid and is generally considered safe for a patient who is one day postoperative from a Roux-en-Y surgical procedure. It is easily digestible and does not put undue stress on the digestive system.

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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 nurse is contributing to the plan of care for a client who has a gastrostomy tube through which he is receiving continuous enteral feedings. Which of the following interventions should the nurse include in the plan?

Correct Answer is B

Explanation

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Correct Answer is A

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)