A nurse is caring for a client who has a prescription for metoprolol. The nurse measures the client's vital signs and notes that the client's apical heart rate is 49/min. The nurse should prepare to administer which of the following medications?

(A) “I promise I won’t tell anyone about this.”: This statement is inappropriate because it is the nurse’s legal and ethical duty to report any suspicion or evidence of child abuse to the appropriate authorities. Keeping the information confidential could potentially endanger the child.

(B) “Let’s discuss what you have told me with your family members.”: This statement could potentially put the child at further risk, especially if the abuser is a family member. The child’s safety is the primary concern, and discussing the abuse with family members without the involvement of child protective services could be harmful.

(c) “Your family is bad for doing this to you.”: This statement is judgmental and unprofessional. It’s important to maintain a neutral stance and focus on the child’s feelings and safety rather than placing blame.

(D) “It is not your fault that this happened.”: This is the most appropriate response. It’s crucial to reassure the child that they are not to blame for the abuse. This can help alleviate feelings of guilt or shame that the child may be experiencing. The nurse should also take steps to ensure the child’s immediate safety and report the abuse to the appropriate authorities.

(A) Place the client in high-Fowler’s position and encourage the use of incentive spirometer and coughing: This is the most appropriate action. The high-Fowler’s position can help improve lung expansion and gas exchange, while the use of an incentive spirometer and coughing can help clear secretions and improve ventilation. This is particularly important for a client who is postoperative following an open thoracotomy.

(B) Switch oxygen to a nonrebreather mask: Switching to a nonrebreather mask may deliver a higher concentration of oxygen, but it does not address the underlying issue of impaired gas exchange due to decreased lung expansion and retained secretions.

(C) Position the client prone and have the respiratory therapist perform postural drainage: While postural drainage can help clear secretions, it may not be comfortable or safe for a client who is 1 day postoperative following an open thoracotomy.

(D) Increase oxygen to 70%: Increasing the oxygen concentration may improve the client’s oxygen saturation, but it does not address the underlying issue of impaired gas exchange due to decreased lung expansion and retained secretions. Furthermore, excessively high concentrations of oxygen can have harmful effects, such as oxygen toxicity or suppression of the respiratory drive in some clients.