The nurse is planning care for a client who has a fourth-degree midline laceration that occurred during vaginal delivery of an 8-pound 10-ounce (3674 grams) infant.

Which intervention has the highest priority for this client?

• A bowel patern is the frequency, consistency, and appearance of a person's bowel movements. A normal bowel patern is what's normal for each person, and it can vary depending on factors such as diet, age, physical activity, and health conditions.
• A focused gastrointestinal system assessment includes collecting subjective data about the patient's history of gastrointestinal disease, signs and symptoms of gastrointestinal problems, diet and nutrition, and bowel patern. It also includes inspecting and auscultating the abdomen for any abnormalities³.
• When a client reports having a bowel movement three days ago, the first action that the practical nurse should implement is to determine the client's usual bowel patern. This will help to evaluate if the client is experiencing constipation or if this is their normal frequency. It will also help to identify any changes or risk factors that may affect the client's bowel function.

Therefore, option B is the correct answer, while options A, C, and D are incorrect.

Option A is incorrect because administering a stool softener without assessing the client's bowel patern may not be appropriate or effective.

Option C is incorrect because encouraging ambulation may help to stimulate bowel activity, but it is not the first action to take.

Option D is incorrect because recommending dietary changes may be helpful for preventing or treating constipation, but it is not the first action to take.

The correct answer is choiced. Notify your healthcare provider if you start having abdominal pain.

Choice A rationale:

Exenatide does not act in the same way as insulin. It is a GLP-1 receptor agonist that enhances glucose-dependent insulin secretion, suppresses glucagon secretion, and slows gastric emptying.

Choice B rationale:

Exenatide should be injected within 60 minutes before the morning and evening meals, not within 30 minutes before or after a meal.

Choice C rationale:

There are precautions about taking exenatide with other medications. It can affect the absorption of oral medications, so timing and interactions need to be considered.

Choice D rationale:

Abdominal pain can be a sign of pancreatitis, a serious side effect of exenatide.It is important to notify the healthcare provider if this symptom occurs.