The nurse continues to care for the client.

Exhibits

The nurse administers the client's scheduled medication. Which of the following adverse effects of the medication should the nurse monitor the client for? Select all that apply.

Rationale:

A. Raise the head of the bed when transferring a client from a bed to a stretcher: Raising the head of the bed alters body mechanics and may complicate the transfer by increasing the angle of elevation, which can lead to strain or improper alignment during the move.

B. Use a pillow underneath the client's head when repositioning a client in bed: A pillow can aid in comfort but does not contribute to safe body mechanics during repositioning. It may also interfere with alignment or reduce the ability to properly lift or turn the client.

C. Transfer on the client's weaker side when moving a client from a bed to a chair: Transferring toward the weaker side increases the risk of instability and falls. Safe ergonomic practice involves moving clients toward their stronger side to encourage participation and minimize staff effort.

D. Use a lateral transfer device when moving a client from a bed to a stretcher: Lateral transfer devices reduce friction between surfaces, making it easier to move the client without excessive force. This protects both the client and the nurse from musculoskeletal injuries and supports safe practice.

Rationale:

A. "I will avoid strenuous exercise.": Physical activity, including regular moderate exercise like walking, actually helps stimulate bowel function. Avoiding exercise may worsen constipation rather than prevent it.

B. "I will increase my intake of high-fiber foods.": A high-fiber diet supports regular bowel movements by increasing stool bulk and promoting peristalsis. This is a key strategy for preventing opioid-induced constipation.

C. "I will take a bulk-forming laxative every day.": Bulk-forming laxatives can be helpful, but daily use should be discussed with a provider, as they can worsen constipation if fluid intake is insufficient. Dietary changes are usually the first recommended step.

D. "I will limit my fluid intake to 1 liter per day.": Limiting fluid intake can lead to dehydration and hard stools, worsening constipation. Adequate hydration is essential to help fiber work effectively and support regular bowel function.