Nurse Melinda is caring for a client who is postoperative following a pelvic exenteration and the physician changes the client's diet from NPO status to clear liquids. The nurse makes which priority assessment before administering the diet?

A. Bowel sounds
B. Ability to ambulate
C. Incision appearance
D. Urine specific gravity


Answer: A
Explanation: The client is kept NPO until peristalsis returns, usually in 4 to 6 days. When signs of bowel function return, clear fluids are given to the client. If no distention occurs, the diet is advanced as tolerated. The most important assessment is to assess bowel sounds before feeding the client. Options B, C, and D are unrelated to the subject of the question.

Nursing

You might also like to view...

In planning a new wing, the nurse manager complies with the workplace safety requirements of the Occupational Safety & Health Administration (OSHA). Which of the following groups is considered to be at high risk for violence in the workplace?

a. Pediatric staff b. Postsurgical unit staff c. Emergency Department staff d. Medical oncology unit staff

Nursing

To conduct the Romberg test, the nurse asks the patient to stand with the feet together and eyes closed. What must the nurse observe for the test to be considered normal?

1. swaying from side to side 2. minimal swaying for up to 20 seconds 3. sufficient balance to hold completely still without swaying 4. swaying to one side and loss of balance

Nursing

A nurse is helping a father understand expected behaviors of his 8-year-old son. The nurse is teaching the father that, by this age, the boy is in the concrete operations stage of development

What are the most common characteristics that the nurse can tell the father that are displayed by children at this level according to Piaget's theory of cognitive development? A) They have the ability to understand quantities, such as weight and volume. B) They have the ability to solve complex problems. C) They have the ability to investigate and explore the environment. D) They have the ability to learn by touching.

Nursing

Calculate the DMFN for a child weighing 3.25 kg: ________.

Fill in the blank(s) with the appropriate word(s).

Nursing