Prior to performing digital removal of a fecal impaction, what is the most important assessment for the nurse to perform?

Abdominal girth.

Breath sounds.

Bowel sounds.

Vital signs.

Answer and Explanation

The Correct Answer is D

Prior to performing digital removal of a fecal impaction, it is important for the nurse to assess the client’s vital signs.

This includes checking the client’s blood pressure, pulse rate, respiratory rate, and temperature.

These measurements can provide important information about the client’s overall health status and can help the nurse determine if it is safe to proceed with the procedure.

Choice A is not correct because abdominal girth is not the most important assessment for the nurse to perform prior to performing digital removal of a fecal impaction.

Choice B is not correct because breath sounds are not the most important assessment for the nurse to perform prior to performing digital removal of a fecal impaction.

Choice C is not correct because bowel sounds are not the most important assessment for the nurse to perform prior to performing digital removal of a fecal impaction.

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Correct Answer is C

Explanation

The most important intervention the nurse should take when administering these medications to the client is to assess the client’s pain level and administer the appropriate medication based on the level of pain.

Choice A is not the correct answer because administering all medications at the same time may not provide effective pain relief and could result in overmedication.

Choice B is not the correct answer because administering the medication with the highest dose first may not provide effective pain relief and could result in overmedication.

Choice D is not the correct answer because administering the medication with the longest duration of action first may not provide immediate pain relief.

A. To ambulate without discomfort. B. To take analgesics as prescribed. C. To show evidence of incision healing. D. To avoid pain-causing activity.

Correct Answer is A

Explanation

The goal of the care plan should be to help the client overcome his activity intolerance related to pain.

This can be achieved by helping him to ambulate without discomfort.

Choice B is not the answer because taking analgesics as prescribed may help manage the pain but does not address the problem of activity intolerance.

Choice C is not the answer because showing evidence of incision healing is important but does not address the problem of activity intolerance.

Choice D is not the answer because avoiding pain-causing activity may help manage the pain but does not address the problem of activity intolerance.

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Prior to performing digital removal of a fecal impaction, what is the most important assessment for the nurse to perform?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A postoperative client has been prescribed three different analgesics for different levels of pain. What is the most important intervention the nurse should take when administering these medications to the client?

Correct Answer is C

Explanation

Correct Answer is A

Explanation

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