A nurse is preparing to perform an abdominal assessment on a child. Identify the sequence the nurse should follow. (Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.)

A. Cleanse the skin prior to the procedure: Cleansing the skin before applying the transdermal analgesic cream is essential to remove any dirt, oils, or contaminants that could interfere with its absorption. This step helps ensure optimal drug delivery and effectiveness.
B. Apply the medication an hour before the procedure begins: Applying the transdermal analgesic cream an hour before the procedure allows sufficient time for the medication to be absorbed through the skin and reach its therapeutic effect. This timing ensures that the analgesic properties are in place when the IV insertion procedure starts.
C. Use a visual pain rating scale to evaluate the effectiveness of the treatment: Using a visual pain rating scale can help assess the child's pain level before and after applying the transdermal analgesic cream. This evaluation provides valuable feedback on the cream's effectiveness in providing pain relief.
D. Apply to intact skin: Transdermal medications are designed to be absorbed through intact skin. Applying the cream to intact skin ensures proper absorption and effectiveness of the analgesic medication.
E. Spread the cream over the lateral surface of both forearms. This option might not be necessary or appropriate for the intended purpose. The choice of application site for transdermal analgesic cream depends on the specific medication and the area of pain. While the lateral surface of the forearms can be a suitable site, it may not always be necessary or feasible to apply the cream to both forearms, especially if the intended IV insertion site is on one arm.

A. Provide reassurance to the client and parents: While reassurance is important, it is not the priority action when caring for an adolescent client with a newly applied fiberglass cast for a fractured tibia. Ensuring adequate neurovascular status is critical to prevent complications associated with impaired circulation or nerve function.
B. Perform a neurovascular assessment: This is the correct action and the priority when caring for a client with a newly applied cast. The nurse should assess the client's neurovascular status by evaluating circulation, sensation, and movement distal to the casted limb. Changes in color, temperature, sensation, or movement could indicate impaired circulation or nerve function, which require immediate intervention to prevent complications such as compartment syndrome.
C. Apply an ice pack to the casted leg: While applying ice may help reduce swelling and discomfort, it is not the priority action when caring for a client with a newly applied cast. Additionally, applying ice directly to the cast may not effectively reach the skin and underlying tissues, potentially causing discomfort without providing significant benefit.
D. Explain the discharge instructions to the client and parents: Providing discharge instructions is important for client education, but it is not the priority action immediately after applying a cast. Ensuring the client's safety and well-being by performing a neurovascular assessment takes precedence to identify and address any potential complications associated with the cast.