Which response is best when a patient refuses a stool softener after pituitary surgery?
"You need the stool softener because it will be hard to defecate while you remain in bed."
"Any manipulation of the pituitary gland can cause difficulty in defecation, so stool softeners are important after your surgery."
"It is important you do not strain during bowel movements because this could result in increased pressure on your surgical site."
"You can choose not to take the stool softener if you feel you do not need it."
The Correct Answer is C
A. "You need the stool softener because it will be hard to defecate while you remain in bed.": This is not the most appropriate response. While immobility can make bowel movements more difficult, the primary concern following pituitary surgery is the avoidance of straining due to the potential for increased intracranial pressure (ICP). The emphasis should be on avoiding pressure on the surgical site rather than general difficulties from immobility.
B. "Any manipulation of the pituitary gland can cause difficulty in defecation, so stool softeners are important after your surgery.": This is misleading. While pituitary surgery may influence certain bodily functions, the most critical concern is preventing straining to avoid raising ICP. The focus should be on explaining the rationale for avoiding pressure on the surgical site.
C. "It is important you do not strain during bowel movements because this could result in increased pressure on your surgical site.": This is the correct response. Straining during bowel movements can increase ICP, which could potentially compromise healing or lead to complications after pituitary surgery. This explanation directly addresses the patient's safety and emphasizes the need for stool softeners to prevent straining.
D. "You can choose not to take the stool softener if you feel you do not need it.": This response is inappropriate because it does not emphasize the importance of preventing straining, which is a critical consideration after pituitary surgery. The nurse should provide education on the necessity of the stool softener to avoid complications rather than leaving the decision solely to the patient.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. The client is likely experiencing an allergic reaction to penicillin, such as anaphylaxis, which can cause symptoms like itching, dizziness, and difficulty breathing. The first step is to stop the infusion immediately to prevent further exposure to the allergen.
B. Elevating the head of the bed might be helpful if the client is experiencing respiratory distress, but stopping the infusion is the priority action.
C. Auscultating the client's breath sounds may be useful later to assess the severity of respiratory distress, but it is not the first action in an acute allergic reaction.
D. Calling the provider is important, but the immediate priority is stopping the infusion to prevent further harm from the allergic reaction.
Correct Answer is B
Explanation
A. Using a lift sheet is helpful for preventing injury and ensuring safe handling of the patient, but it is not the most critical safety measure for a patient with Cushing’s syndrome.
B. Assisting the patient to change positions slowly is the most important safety measure for a patient with Cushing’s syndrome. Patients with Cushing’s syndrome often have osteoporosis and a risk of fractures due to prolonged exposure to high cortisol levels, which can lead to weakened bones. Orthostatic hypotension may also occur, so changing positions slowly can prevent falls.
C. Padding the siderails of the bed is typically done for patients at risk of seizures or those with neurological issues, not as a primary concern for patients with Cushing’s syndrome.
D. While keeping suction equipment at the bedside is important for patients at risk of aspiration or respiratory issues, it is not the most critical measure for a patient with Cushing’s syndrome. The most significant concern is the risk of falls and fractures due to bone weakening and potential hypotension.
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