The practical nurse (PN) is caring for a client with a new prescription for fluticasone furoate nasal spray, a glucocorticoid prescribed for the client's nasal allergy symptoms. In reinforcing instructions about self-administration of the nasal spray, the PN should emphasize the need for the client to take which action before self-administration?

The client's question about whether the surgical opening will be visible suggests that they have concerns or misconceptions about the upcoming fecal diversion surgery. By reviewing the client's expectations of elimination after surgery, the PN can provide accurate information and address any anxieties or concerns the client may have.

The other options are not directly related to the client's question and are not the most appropriate actions to take in this situation:
A. Determining if this is the client's first indwelling catheter is unrelated to the client's question about the visibility of the surgical opening. It may be important to assess the client's history of urinary catheter use for other purposes, but it does not address the client's immediate concern.
B. Asking the client if they finished the bowel sterilization prescription is also unrelated to the visibility of the surgical opening. While bowel sterilization may be a part of the preoperative preparation for fecal diversion surgery, it does not address the client's questions and concerns.
D. Verifying that the client had nothing by mouth (NPO) for the past 24 hours is important for general preoperative care but does not address the client's specific question about the visibility of the surgical opening.

The vital sign trends that indicate increased intracranial pressure (ICP) and should be reported to the charge nurse are:

Bradycardia: A slow heart rate can be a sign of increased ICP.

Irregular respiratory patterns: Abnormal breathing patterns, such as irregular or Cheyne-Stokes respirations, can be indicative of increased ICP.

Widening pulse pressure: An increased difference between systolic and diastolic blood pressure (widening pulse pressure) can be a sign of increased ICP.

A- Heart rate above 110 beats/minute, elevated respiratory rate, and hypotension: While an elevated heart rate and respiratory rate can be associated with increased ICP, hypotension (low blood pressure) is not typically seen in this condition. Hypotension can be a sign of other factors, such as hypovolemia or shock, which may or may not be related to the head injury.

B- Bounding pulse rate, groaning respiratory effort, and elevated blood pressure: Bounding pulse rate and elevated blood pressure are not specific to increased ICP. They can be influenced by other factors such as pain, anxiety, or medications. Groaning respiratory effort may indicate respiratory distress, but it is not directly related to increased ICP.

C- Thready rapid pulse, trembling, perspiration, weakness, and irritability: These signs and symptoms can be associated with various conditions such as anxiety, stress, or other physiological responses. While they may occur in the context of increased ICP, they are not specific to this condition alone.