Nokea
A client is admitted with a bowel obstruction. The client has nausea, vomiting, and crampy abdominal pain. The physician has written orders for the client to be up ad lib, to have narcotics for pain, to have a nasogastric tube inserted if needed, and for I.V. Ringer's Lactate and hyperalimentation fluids. The nurse should do the following in order of priority from first to last:
- A. Assist with ambulation to promote peristalsis.
- B. Administer Ringer's Lactate.
- C. Insert a nasogastric tube.
- D. Start an infusion of hyperalimentation fluids.
Correct Answer: B,C,A,D
Rationale: The priority is to administer Ringer's Lactate (B) to correct dehydration, followed by inserting a nasogastric tube (C) if needed to decompress the bowel. Ambulation (A) can promote peristalsis but is less urgent, and hyperalimentation fluids (D) are started later for long-term nutrition. CN: Physiological adaptation; CL: Synthesize
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