A nurse is contributing to the plan of care for a client 48 hr following cesarean birth. Which of the following nonpharmacologic interventions should the nurse include to reduce pain from intestinal gas?

Provide the client with a carbonated beverage.

Encourage the client to lie on their right side.

Encourage the client to ambulate.

Provide the client with straws for beverages.

Answer and Explanation

The Correct Answer is A

Choice A reason:

The nurse should provide the client with a carbonated beverage as a nonpharmacologic intervention to reduce pain from intestinal gas. Carbonated beverages, like soda or sparkling water, can help alleviate gas by promoting burping, which releases trapped gas from the digestive system. The effervescence of the carbonated drink can help relieve the discomfort caused by accumulated gas, offering relief to the client.

Choice B reason:

Encouraging the client to lie on their right side is not an effective nonpharmacologic intervention for reducing pain from intestinal gas. Although positioning can sometimes aid in relieving discomfort, lying on the right side does not specifically target the reduction of gas. Therefore, it is not the most appropriate choice in this scenario.

Choice C reason:

Encouraging the client to ambulate is a beneficial nonpharmacologic intervention for various post-operative conditions. However, when it comes to reducing pain from intestinal gas, it may not be as effective as other options. While movement can aid in gas passage through the digestive system, it might not be the most immediate or direct solution for alleviating the client's discomfort.

Choice D reason:

Providing the client with straws for beverages does not directly address the issue of intestinal gas. It is an unrelated intervention and may not provide any significant relief for the client's discomfort.

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Correct Answer is D

Explanation

Swaddle the newborn during the treatment. Choice A reason:

Apply lotion to the newborn's skin twice per day. Rationale: The nurse should not apply lotion to the newborn's skin during phototherapy. Phototherapy involves exposing the baby's skin to light to treat hyperbilirubinemia. Applying lotion may interfere with the effectiveness of the treatment or cause adverse reactions.

Choice B reason:

Check the newborn's blood glucose every 2 hours. Rationale: While monitoring the newborn's blood glucose is an essential part of neonatal care, it is not directly related to phototherapy or the treatment of hyperbilirubinemia. Glucose monitoring is typically done to assess for hypoglycemia or other metabolic disturbances.

Choice C reason:

Swaddle the newborn during the treatment. Rationale: The newborn should not be swaddled during phototherapy because it limits exposure of the skin to the phototherapy lights, which is essential for reducing bilirubin levels.

Choice D reason:

Remove the newborn's eye mask during feedings. Rationale:The eye mask is used to protect the newborn's eyes from the bright lights during phototherapy, but it can be removed for feeding. It’s important to ensure that the newborn is fed properly, so removing the mask during feeding is a reasonable and necessary intervention.

A. WBC count 10,000/mm. B. Hgb 6.8 g/dL. C. Creatinine 0.8 mg/dL. D. Potassium 3.5 mEq/L.

Correct Answer is B

Explanation

Choice A reason:

The WBC count of 10,000/mm is within the normal range, indicating a normal white blood cell count. There is no cause for concern, and the nurse does not need to report this result to the provider.

Choice B reason:

The Hgb level of 6.8 g/dL is significantly below the normal range, which indicates severe anemia. Menorrhagia, or heavy menstrual bleeding, could be a potential cause of this low hemoglobin level. Anemia can lead to various complications, including fatigue, weakness, and decreased oxygen delivery to tissues. This result requires immediate attention, and the nurse should promptly report it to the healthcare provider for further evaluation and management.

Choice C reason:

The Creatinine level of 0.8 mg/dL is within the normal range. Creatinine is a marker of kidney function, and a normal value suggests that the kidneys are functioning adequately. Since the result is normal, the nurse does not need to report this to the provider.

Choice D reason:

The Potassium level of 3.5 mEq/L is within the normal range, indicating a normal potassium level. There is no immediate concern with this result, and the nurse does not need to report it to the provider.

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A nurse is contributing to the plan of care for a client 48 hr following cesarean birth. Which of the following nonpharmacologic interventions should the nurse include to reduce pain from intestinal gas?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is B

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