A nurse is assisting in the care of a 72-year-old female client who recently had a stroke and is being monitored for complications.

Exhibits

Complete the following sentence by using the lists of options. The client is at risk for developing

dropdown

due to

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.

The correct answer is Constipation / Opioid use.

Constipation is a common side effect of opioid use. The client is receiving oxycodone for pain management, which can slow down the digestive system, leading to constipation.

Pressure injuries, also known as pressure ulcers or bedsores, are a risk due to prolonged immobility. This is especially relevant for a client who is postoperative and has limited movement. However, this was not selected as the primary condition based on the given clues.

Hypoglycemia (low blood sugar) is not directly indicated by the client's current medications or conditions. The client is receiving IV dextrose, but there is no indication of a risk of hypoglycemia in the provided information.

Confusion can occur in clients with cognitive impairments or due to medication side effects, but it is not specifically indicated as a primary risk in this case.

Dysrhythmias (abnormal heart rhythms) can be caused by imbalances in potassium or sodium levels, among other factors, but there is no evidence of such imbalances or related symptoms in this client’s case.

Choice A rationale

"Let's talk about what you're thinking.”. This response encourages open communication and allows the nurse to address any concerns or confusion the client may have. It shows empathy and helps build a therapeutic relationship.

Choice B rationale

"Is this something you think you can do?" While this question assesses the client's confidence, it may not address underlying concerns that cause distraction. The focus should be on understanding the client's thoughts and feelings first.

Choice C rationale

"Are you feeling okay?" This question is more about physical well-being, which may not be the reason for the client's distraction. It's better to address emotional or cognitive concerns related to the teaching session.

Choice D rationale

"Do you need more time to absorb this information?" While offering more time can be helpful, it doesn't directly address the client's distraction. Engaging the client in a conversation about their thoughts can be more effective in understanding their needs.