Anatomy & Physiology I/II · practice question

A 62-year-old client on a postoperative unit is being evaluated for nursing care related to gastrointestinal digestion and absorption. Assessment data include pain increases from 3/10 to 8/10 over 30 minutes. Which nursing action should the nurse take first?

Multiple choiceMediumnclex-rn-bsnnclex-validatednclex-2026anatomy-physiology

Document the finding and recheck at the end of the shift without further assessment.Implement the final step of the care plan before assessing the client.Perform a focused assessment for immediate risk, then implement the safest intervention per protocol.Document the client as stable without reassessment.

Answer and explanation

Correct answer

C. Perform a focused assessment for immediate risk, then implement the safest intervention per protocol.

Why

First-action questions on the NCLEX require assessment and safety before treatment, documentation alone, or delegation of nursing judgment.

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A 62-year-old client on a postoperative unit is being evaluated for nursing care related to gastrointestinal digestion and absorption. Assessment data include pain increases from 3/10 to 8/10 over 30 minutes. Which nursing action should the nurse take first?

Correct answer

Why

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