Exhibits

The practical nurse (PN) calls the healthcare provider to notify them that the heart rate is too low to administer the digoxin.

Place the nurse statements in Situation, Background, Assessment, Recommendation (SBAR) format. Each column must have at only one answer selected.

A. Assist the client to perform active range of motion and back exercises: Active exercises can be beneficial in rehabilitation phases but may worsen pain if done too early or without proper pain control. Immediate strategies should focus on comfort and supporting medication effectiveness before promoting activity.
B. Force fluids and progress diet to include milk products: While hydration and nutrition are important for overall health, they do not directly enhance the immediate effectiveness of analgesics. This intervention is unrelated to managing or reducing the client's current low back pain.
C. Reposition the client with proper alignment and massage the lower back: Proper repositioning reduces strain on the spine, improves comfort, and enhances the action of analgesics. Gentle massage promotes circulation and relaxation, helping to amplify pain relief when combined with medication.
D. Encourage the client to take deep breaths and to ambulate frequently: Deep breathing and early ambulation are excellent for preventing complications like pneumonia and deep vein thrombosis especially in clients with decreased mobility due to pain but may not be appropriate as an initial intervention to maximize immediate pain relief from analgesics.

A. Maintain sterile technique during specimen collection: Sterile technique is required for urine cultures, not for 24-hour urine collections. For a timed urine collection, clean collection techniques are sufficient to accurately measure excretion over a full day.
B. Assist the client to cleanse the perineal area prior to voiding: While perineal hygiene is important, it is not the primary step when starting a 24-hour urine collection. The critical action is ensuring that the first void is discarded to properly begin timing the collection period.
C. Instruct the client to discard the first voided specimen: The first void is discarded to ensure the collection accurately measures substances excreted during the full 24-hour period. Timing officially starts after discarding the initial urine, and every subsequent void must be collected.
D. Insert an indwelling urinary catheter: Inserting an indwelling catheter is unnecessary unless the client is unable to void independently. Most 24-hour urine collections are performed using normal voiding and collection into a clean container.