A nurse is reviewing risk factors for a client who had a myocardial infarction. Which of the following should the nurse consider to be a nonmodifiable risk factor?

A. Interpret the client's need for pain medication: Determining the need for analgesia requires professional nursing judgment and assessment, which is outside the AP’s scope of practice. The nurse must evaluate pain and make medication decisions.

B. Change a sterile dressing on a client's open incisional wound: Sterile dressing changes involve invasive procedures and assessment of wound healing, which are nursing responsibilities. APs can assist with non-sterile care but cannot perform sterile interventions independently.

C. Educate a client on the use of a glucometer: Patient education involves teaching, assessing understanding, and clinical judgment, all of which require nursing expertise. APs can reinforce teaching but cannot independently instruct clients on medical device use.

D. Perform cardiopulmonary resuscitation on a client: CPR is a basic life-saving procedure that APs are trained and authorized to perform in emergencies. This task falls within the AP’s scope of practice and can be done under general supervision until advanced help arrives.

Rationale

• Irrigate indwelling urinary catheter with 50 mL normal saline: Following perineal prostatectomy, bladder spasms, pink urine, and a sensation of fullness can indicate catheter blockage from clots. Gentle irrigation with a small volume ensures catheter patency and relieves obstruction. The client’s decreasing urine output despite increased intake further supports the need for irrigation. Restoring flow prevents retention and reduces discomfort from bladder spasms.

• Apply warm compresses to the incision site: Heat increases vasodilation and can worsen postoperative bleeding in a highly vascular perineal area. A prostatectomy incision requires protection from excessive warmth to reduce hemorrhage risk. Additionally, warm compresses could increase swelling and discomfort.

• Maintain bed rest for 2 days postoperatively: Early ambulation is essential to prevent postoperative complications such as DVT, which is especially important given the client’s history of thrombosis. This client is already independently ambulating, which should be encouraged. Bed rest would increase clot formation risk and impair bowel function, worsening constipation and pain.

• Place a blanket roll under the client’s knees while in bed: Placing pillows or rolls under the knees promotes venous stasis and increases DVT risk, which is dangerous for this client with a past history of thrombosis. Knee flexion also strains the perineal surgical area and may increase pain. Maintaining legs flat encourages optimal circulation and reduces risk of clot formation.