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Comparing capillary refill assesses vascular perfusion, not nerve compression. Carpal tunnel syndrome involves median nerve entrapment, causing pain and paresthesia, not circulatory issues. Capillary refill is normal in this condition, making this action irrelevant for diagnosing the client’s hand pain and numbness.

Determining sleeping position may identify symptom triggers, like wrist flexion, but is not a diagnostic test. Carpal tunnel syndrome requires physical assessment, like Tinel’s sign, to confirm median nerve compression. Sleeping position is secondary, providing context but not direct evidence of the condition.

Applying pressure over the ulnar artery assesses circulation, not median nerve compression. Carpal tunnel syndrome affects the median nerve, causing pain and tingling, not ulnar nerve or vascular issues. This action is irrelevant, as it does not evaluate the neurological symptoms described by the client.

Platelets are unaffected by hydrocortisone in Addison’s disease. Hydrocortisone replaces cortisol, regulating metabolism, not coagulation. Platelet monitoring is relevant for bleeding disorders, not adrenal insufficiency, making this value less critical than glucose, which is directly impacted by cortisol’s gluconeogenic effects.

Albumin reflects nutritional status but is not directly altered by hydrocortisone. Addison’s disease and hydrocortisone affect glucose and electrolytes via cortisol’s metabolic roles, not protein synthesis. Albumin is secondary, as glucose monitoring addresses immediate metabolic complications of corticosteroid therapy.

Serum electrolytes, like sodium and potassium, are affected by Addison’s, but hydrocortisone primarily corrects hyponatremia and hyperkalemia. Glucose is more critical, as hydrocortisone’s glucocorticoid effects directly raise blood sugar, posing immediate metabolic risks, making this value secondary to glucose monitoring.

Severe headache with photosensitivity suggests meningitis or dehydration but is less urgent than rebound tenderness, which indicates peritonitis. In acute abdominal pain, neurological symptoms are secondary to potential surgical emergencies like appendicitis, requiring immediate reporting for possible operative intervention.

Petechial hemorrhage under the eyes suggests coagulopathy or increased intracranial pressure but is less specific to acute abdominal pain. Rebound tenderness directly indicates a surgical emergency like appendicitis, making petechiae a secondary concern requiring evaluation after addressing peritoneal signs.

Dark green emesis indicates bile or obstruction but is less urgent than rebound tenderness, which signals peritonitis. Vomiting is managed with fluids, but tenderness suggests a surgical condition like appendicitis, requiring immediate reporting to prevent complications like perforation.

Measuring intake and output monitors fluid balance but does not address blood clots obstructing TURP drainage. Clots risk bladder distension or hemorrhage, and increasing irrigation flow directly clears the tubing, making this action secondary to preventing immediate complications in post-prostate surgery.

Providing oral fluids increases urine output but does not directly clear blood clots in TURP drainage. Clots require irrigation adjustment to prevent obstruction, and oral hydration is secondary, as it does not address the immediate risk of catheter blockage or bladder complications.

Administering an antispasmodic addresses bladder spasms but not blood clots in TURP drainage. Clots cause obstruction, not spasms, and increasing irrigation flow directly resolves the issue, making antispasmodics irrelevant for the immediate problem of maintaining catheter patency.

Determining the quickest onset is important but secondary to matching pain severity with dosing. Pain scale rating guides appropriate medication selection, as prescriptions are dosed for specific pain levels, ensuring effective relief without overuse, making this action less critical initially.

Asking the client to choose medication is inappropriate, as patients lack expertise to select based on pharmacology. Pain scale rating informs the nurse’s decision, aligning with prescribed doses, ensuring safe and effective analgesia, making this action incorrect for professional nursing practice.

Documenting pain is necessary but not the first action. Comparing pain scale rating with dosing ensures appropriate medication selection, addressing pain effectively before recording. Documentation follows intervention, making this action secondary to selecting the correct analgesic based on severity.

Discussing medications with the provider is necessary but vague and not actionable during the call. Bringing medication containers provides concrete data, ensuring accurate preoperative reconciliation, reducing risks like drug interactions, making this response less effective for immediate medication assessment.

Bringing prescription records is helpful but less direct than medication containers, which show current drugs, doses, and adherence. Records may be incomplete, and containers allow visual verification, ensuring accurate perioperative planning, making this response secondary to physical medication review.

Obtaining records from the provider is time-consuming and may delay preoperative planning. Medication containers provide immediate, accurate data for reconciliation, reducing risks of errors, making this response less practical than having the client bring physical containers for direct review.

Brown, solid fecal matter is normal 24 hours post-colostomy, indicating bowel function. This does not suggest complications like ischemia or obstruction, requiring no immediate reporting, as it aligns with expected postoperative outcomes, making this finding benign.

Streaks of bright red blood from the stoma suggest minor trauma or irritation, common post-colostomy. This is less urgent than purple mucosa, which indicates ischemia, a life-threatening issue, making bleeding a secondary concern requiring monitoring but not immediate surgical intervention.

Absent bowel sounds in the left lower quadrant are expected post-bowel surgery due to ileus. This is less urgent than purple stoma mucosa, which signals necrosis, requiring immediate action, making bowel sounds a normal postoperative finding not warranting urgent reporting.

Educating on narcotic dependency is inappropriate during severe pain (8/10). Stage IV bone cancer requires aggressive pain control, and dependency concerns are secondary. Administering medications relieves suffering, aligning with palliative goals, making education irrelevant at this acute pain crisis moment.

Waiting for a pain score of 10 delays relief, worsening suffering in stage IV bone cancer. Severe pain (8/10) requires immediate intervention with opioid and non-opioid drugs, as delaying treatment exacerbates distress, making this approach ineffective and contrary to pain management protocols.

Alternating IV and IM analgesics is inefficient and delays relief. Simultaneous opioid and non-opioid use addresses severe pain (8/10) more effectively, targeting different pain pathways, reducing opioid needs, and improving outcomes, making alternating routes less effective for immediate control.

Inspecting peripheral vein distention assesses superficial thrombosis, not deep vein thrombosis (DVT), which occurs in deep veins like the femoral. DVT presents with calf inflammation, not visible vein distention, making this assessment less specific for diagnosing the condition’s classic signs.

Observing breathing pattern changes detects pulmonary embolism, a DVT complication, not DVT itself. Calf inflammation is a primary DVT sign, and breathing changes are secondary, making this assessment irrelevant for initial DVT evaluation, focusing on systemic rather than localized findings.

Palpating pedal pulses assesses arterial flow, not venous thrombosis. DVT causes calf inflammation and swelling, not pulse changes, unless severe. This assessment is less relevant, as DVT primarily affects venous return, making calf inflammation the priority for diagnosis.