The nurse is caring for a client post-operatively following an open (incisional) cholecystectomy. Which would be the priority nursing intervention for this client?

Administer a narcotic analgesic every two hours.

Encourage a low-fat diet the first post-op day.

Encourage the use of the incentive spirometer.

Ambulate the client in the hall the first post-op evening.

Answer and Explanation

The Correct Answer is C

A. While administering a narcotic analgesic may be necessary for pain management, it does not address the immediate post-operative needs related to respiratory function and mobility.
B. Encouraging a low-fat diet is important after a cholecystectomy, but this can be addressed after ensuring the client's respiratory function and mobilization are stable.
C. Encouraging the use of the incentive spirometer is the priority intervention as it promotes lung expansion, reduces the risk of atelectasis, and improves oxygenation, which is crucial in the post-operative period.
D. While ambulating the client is important for recovery and preventing complications such as deep vein thrombosis, it should follow ensuring that the patient is able to effectively use the incentive spirometer to maintain respiratory function first.

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Correct Answer is C

Explanation

A. Reading glasses do not offer sufficient protection against the light sensitivity that results from photodynamic therapy. Special protective eyewear is needed to protect the eyes from exposure to bright light during recovery.
B. Clients are usually instructed to fast before treatments that involve anesthesia or sedation, such as photodynamic therapy. Eating a full breakfast is not typically recommended before this type of treatment.
C. After photodynamic therapy, clients become extremely sensitive to light, including sunlight. Exposure to sunlight or strong indoor lights can cause skin damage, so clients are advised to avoid sun exposure for at least 6 weeks.
D. Skin markings made for treatment guidance should be preserved between treatments, but this is less critical in photodynamic therapy compared to radiation therapy, where precise location is essential for targeting tumors.

A. to continue the antiepileptic drug to prevent seizure activity B. morphine will be administered post-op for adequate pain control C. to continue taking the daily Aspirin until the day of surgery D. to continue the use of alternative or complementary therapies with family approval

Correct Answer is A

Explanation

A. Continuing antiepileptic drugs is crucial in patients with brain tumors, as these medications help prevent seizure activity, which is a common complication associated with brain tumors and surgical procedures.
B. While pain control is important, the specific medications used for postoperative pain management are determined after surgery; patients should be informed about general pain management strategies rather than specific drug administration.
C. Aspirin, an anticoagulant, should typically be stopped before surgery to reduce the risk of bleeding complications; therefore, patients should not continue taking it unless specifically directed by their healthcare provider.
D. Patients are usually advised to discontinue alternative or complementary therapies before surgery due to potential interactions with anesthesia or surgical procedures, and it should be clarified with the healthcare provider before proceeding.

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The nurse is caring for a client post-operatively following an open (incisional) cholecystectomy. Which would be the priority nursing intervention for this client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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