A nurse is caring for a client who is 24 hr postoperative following abdominal surgery. The client received an opioid analgesic 1 hr ago and now reports a pain level of 2 on a scale of 0 to 10. Which of the following actions should the nurse take?

Maintain the client on bed rest.

Apply a warm, moist compress to the incision area.

Administer an additional dose of pain medication.

Reposition the client.

Answer and Explanation

The Correct Answer is D

Answer is: d. Reposition the client.

Explanation: Repositioning the client can help alleviate pain by redistributing pressure and promoting comfort. Since the client's pain level is relatively low (2 on a scale of 0 to 10), this non-pharmacological intervention is an appropriate initial action.

Choice a. is wrong because maintaining the client on bed rest is not an appropriate action for a pain level of 2. Instead, the nurse should encourage the client to mobilize and perform appropriate exercises to prevent complications related to immobility.

Choice b. is wrong because applying a warm, moist compress to the incision area might not be the best action for a client who is 24 hours postoperative, as it could increase the risk of infection and cause discomfort. Cold compresses are often used in the initial postoperative period to reduce swelling and promote comfort.

Choice c. is wrong because administering an additional dose of pain medication is not necessary at this point, as the client's pain level is relatively low. The nurse should consider non-pharmacological interventions first and reassess the client's pain level to determine the need for further pain relief.

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Correct Answer is B

Explanation

The client takes ibuprofen for headaches. NSAIDs such as ibuprofen can cause gastrointestinal bleeding, which can result in a false positive result on a fecal occult blood test.

Option A is incorrect because breast cancer is not associated with false-positive fecal occult blood results.

Option C is incorrect because citrus juice does not affect the fecal occult blood test.

Option D is incorrect because a hemorrhoidectomy is not associated with false-positive fecal occult blood results.

Reasons why the other options are not answered:

Option A: Breast cancer is not associated with false-positive fecal occult blood results.

Option C: Citrus juice does not affect the fecal occult blood test.

Option D: A hemorrhoidectomy is not associated with false-positive fecal occult blood results.

A. Monitor the client for weight loss. B. Advise the client about increased dry mouth. C. Inform the client of the adverse effect of diarrhea. D. Check the client for increased hypopigmentation under the patch.

Correct Answer is B

Explanation

Advise the client about increased dry mouth. Transdermal clonidine can cause xerostomia, or dry mouth, due to a decrease in salivary secretion. The nurse should advise the client to maintain good oral hygiene and to increase fluid intake to prevent oral and dental problems.

An explanation for incorrect choices:

A. Weight loss is not a common adverse effect or risk associated with transdermal clonidine.

C. Diarrhea can occur with transdermal clonidine, but it is not a common adverse effect or risk.

D. Hypopigmentation is rare with transdermal clonidine; it is more common with corticosteroids.

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A nurse is caring for a client who is 24 hr postoperative following abdominal surgery. The client received an opioid analgesic 1 hr ago and now reports a pain level of 2 on a scale of 0 to 10. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reviewing the results of a client's fecal occult blood screening test. Which of the following findings from the client's history should the nurse identify as potentially causing a false-positive result?

Correct Answer is B

Explanation

A nurse is assisting with the plan of care for an older adult client who has a new prescription for transdermal clonidine. Which of the following information should the nurse include in the plan of care?

Correct Answer is B

Explanation

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