Which of the following is a priority action when the nurse observes paraphimosis in an elderly man?
A) Place the patient on bedrest and assess in two hours.
B) Administer an analgesic for pain.
C) Notify the physician immediately.
D) Teach the patient how to care for his foreskin.
C) Notify the physician immediately.
Explanation: A) Paraphimosis is a medical emergency–failure to resolve the problem can lead to necrosis and gangrene of the glans penis. The goal is to reduce the foreskin to its naturally occurring position over the glans penis. The nurse should not wait two hours to reassess the patient but should call the physician immediately.
B) While the patient may be in pain, the first step is to notify the physician immediately. Paraphimosis is a medical emergency–failure to resolve the problem can lead to necrosis and gangrene of the glans penis.
C) Paraphimosis is a medical emergency–failure to resolve the problem can lead to necrosis and gangrene of the glans penis. The goal is to reduce the foreskin to its naturally occurring position over the glans penis. The nurse should call the physician immediately.
D) While teaching the patient to replace the foreskin after cleaning is important, it is not a priority action.
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