The client is a 27-year-old male who had an exploratory laparotomy 8 days ago following a gunshot wound to the abdomen. The surgeons evacuated a large amount of blood in the peritoneum and repaired a liver laceration. The client was in the intensive care unit (ICU) for 4 days and in the surgical floor for 4 days. He started a regular diet 3 days ago but is now refusing to eat and has had several episodes of vomiting in the past 3 hours. Which action should the nurse take?

Choice A reason: Topical analgesics relieve pain but do not address psoriasis’s underlying inflammation or scaling. Psoriasis involves immune-mediated epidermal hyperproliferation, causing scaly, burning plaques. Analgesics may reduce discomfort temporarily but fail to target the inflammatory process driven by T-cell activation, making this choice ineffective for managing psoriasis symptoms.

Choice B reason: Colloidal oatmeal-based lotion soothes irritated skin but is insufficient for psoriasis, which requires anti-inflammatory treatment. Oatmeal reduces itching in conditions like eczema but does not address psoriasis’s silvery scales or immune-driven inflammation, making it an inadequate choice for controlling the client’s burning, bleeding plaques.

Choice C reason: Topical antifungals treat fungal infections, not psoriasis, which is an autoimmune condition with no fungal etiology. The silvery, scaly plaques result from rapid keratinocyte turnover, not fungal growth, so antifungals are irrelevant, failing to reduce inflammation or scaling in this chronic inflammatory dermatologic condition.

Choice D reason: Topical corticosteroids are effective for psoriasis, reducing inflammation, scaling, and burning by suppressing T-cell activity and cytokine production. They slow epidermal proliferation, alleviating silvery plaques and bleeding. Potent corticosteroids are standard for elbow and palm lesions, making this the appropriate prescription to teach the client for symptom control.

Choice A reason: Teaching a family member to administer eye drops is important for post-discharge care but not immediate post-procedure. Eye protection is critical initially to prevent injury, as drops are typically nurse-administered in-hospital, making this intervention secondary.

Choice B reason: Obtaining vital signs every 2 hours monitors systemic stability but is not specific to eye surgery. Local protection of the surgical site with an eye shield prevents immediate complications like trauma, making vital signs monitoring less urgent post-procedure.

Choice C reason: Providing an eye shield for sleeping is critical immediately post-procedure, as the right eye is vulnerable to accidental trauma during sleep. The shield protects the surgical site, preventing complications like infection or displacement, making this the priority intervention for recovery.

Choice D reason: Deep breathing and coughing exercises prevent pulmonary complications in major surgeries, not minor eye procedures. These actions may increase intraocular pressure, risking surgical site damage, making this intervention inappropriate and potentially harmful post-eye surgery.