The nurse is caring for a client post-operatively following an open (incisional) cholecystectomy. Which would be the priority nursing intervention for this client?

Administer a narcotic analgesic every two hours.

Encourage a low-fat diet the first post-op day.

Encourage the use of the incentive spirometer.

Ambulate the client in the hall the first post-op evening.

Answer and Explanation

The Correct Answer is C

A. While administering a narcotic analgesic may be necessary for pain management, it does not address the immediate post-operative needs related to respiratory function and mobility.
B. Encouraging a low-fat diet is important after a cholecystectomy, but this can be addressed after ensuring the client's respiratory function and mobilization are stable.
C. Encouraging the use of the incentive spirometer is the priority intervention as it promotes lung expansion, reduces the risk of atelectasis, and improves oxygenation, which is crucial in the post-operative period.
D. While ambulating the client is important for recovery and preventing complications such as deep vein thrombosis, it should follow ensuring that the patient is able to effectively use the incentive spirometer to maintain respiratory function first.

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Correct Answer is C

Explanation

A. Using sunscreen while playing sports is an important measure to protect the skin from harmful UV radiation, which contributes to skin cancer; therefore, this statement indicates proper understanding.
B. Monthly self-examinations for suspicious lesions are recommended as part of early detection strategies for skin cancer, demonstrating a proactive approach to skin health.
C. Decreasing the use of a tanning bed to twice a month still poses a significant risk for skin damage and cancer, as tanning beds expose the skin to high levels of UV radiation. This statement indicates a lack of understanding of the dangers associated with artificial tanning.
D. Wearing a hat and sunglasses while in the sun is an effective strategy for minimizing sun exposure to sensitive areas, protecting the skin and eyes from UV rays, indicating proper sun safety practices.

A. limit episodes of anticipatory and delayed emesis B. lessen the client's risk of developing neutropenia C. decrease time intervals between remission D. broaden range of cell kill while minimizing toxicities to the client

Correct Answer is D

Explanation

A. While limiting emesis is important in cancer treatment, combination chemotherapy primarily focuses on improving efficacy and minimizing toxicities, not specifically targeting nausea and vomiting episodes.
B. Combination chemotherapy can actually increase the risk of neutropenia due to the cumulative effects of multiple agents, as each may independently lower white blood cell counts.
C. Decreasing time intervals between remission is not a primary goal of combination chemotherapy; rather, it aims to achieve better overall treatment outcomes.
D. The main rationale for using combination chemotherapy is to broaden the range of cancer cell kill through different mechanisms of action while minimizing the side effects associated with higher doses of a single agent. This approach can improve treatment efficacy and reduce the likelihood of resistance.

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The nurse is caring for a client post-operatively following an open (incisional) cholecystectomy. Which would be the priority nursing intervention for this client?

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Naxlex Comprehensive Predictor Exams

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Explanation

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