The nurse is caring for a client with acute pancreatitis. After pain management, which intervention should be included in the plan of care?

Correct Answer: A

Rationale: Coughing and deep breathing prevent respiratory complications in pancreatitis.

Correct Answer: A

Rationale: A draw sheet's primary role is to reduce friction and shear forces on a patient's skin during repositioning, preventing irritation or breakdown, especially in immobile patients prone to pressure ulcers. It allows nurses to slide the patient smoothly rather than dragging them, protecting vulnerable areas like the sacrum or heels. Enhancing sleep quality might be an indirect benefit but isn't the main intent it's about physical care, not rest. Monitoring blood pressure is unrelated, as draw sheets aren't diagnostic tools. Aiding wound healing could be a secondary effect by avoiding further skin damage, but prevention of irritation is the immediate goal. This technique is a fundamental nursing skill for maintaining skin integrity.

Correct Answer: C

Rationale: A trochanter roll supports proper alignment of the hips and legs by preventing external rotation of the femurs, which can occur in bedridden patients. Placed along the thighs, it maintains neutral positioning, reducing strain on joints and preventing contractures or discomfort. Keeping the patient warm is a blanket's role, not a roll's. Immobilizing limbs is too broad trochanter rolls target specific alignment, not full restriction. Preventing talking is unrelated; it's a physical support tool. Nurses use this to promote musculoskeletal health, especially in immobile patients, ensuring long-term comfort and mobility preservation.

Correct Answer: C

Rationale: During range-of-motion exercises, the nurse aims to prevent pain and contractures stiff, shortened joints that limit movement and cause discomfort common in immobile patients. These exercises maintain joint function and circulation, but overdoing them or ignoring patient feedback can hurt, while neglect leads to permanent stiffness. Muscle strengthening is a benefit, not a prevention target. Joint flexibility is the goal, not something to avoid. Shortness of breath might occur but isn't the primary focus pain and contractures are the key risks. Nurses balance gentle movement with patient tolerance, ensuring long-term mobility and comfort.

Correct Answer: C

Rationale: Providing mouth care after meals and as needed for an unconscious patient prevents bacterial buildup, dry mouth, and infections like pneumonia, addressing immediate hygiene needs. Weekly care is too infrequent, risking oral health decline. Unconscious patients can't request care, making proactive nursing essential. Limiting to visiting hours ignores clinical necessity care timing reflects patient condition, not schedules. Nurses perform this frequently, using swabs or brushes, to maintain mucosal health and comfort, a vital task in dependent care to avert complications.