The nurse is caring for a 20-year-old patient who recently underwent a tonsillectomy.The patient is fully awake and clearing his throat frequently but denies pain.Which action is most important for the nurse to take first?

Question

Quizplus · Accepted Answer

Frequent swallowing or clearing of the throat may indicate bleeding.Further assessment is indicated,and the nurse should look in the patient's mouth to assess for bleeding.
The fully alert adult patient should be placed in semi-Fowler position to ensure adequate ventilation.Offering the patient a grape popsicle is an appropriate intervention once the nurse confirms that the patient is not bleeding.While removing the straw from the tray is an appropriate intervention to prevent bleeding that may result from sucking,the nurse should first ensure that the patient is not currently bleeding.

The Nurse Is Caring for a 20-Year-Old Patient Who Recently