单选题
During afternoon rounds, the nurse finds a male client using a pencil
to scratch inside his knee-to-toe cast. The client is complaining of severe
itching in the ankle area. Which action should the nurse take?
- A. Allow him to continue to scratch inside the cast with a pencil.
- B. Give him a sterile metal object to use for scratching instead of the
pencil.
- C. Encourage him to avoid scratching, and obtain an order for
diphenhydramine (Benadryl) if severe itching persists.
- D. Obtain an order for a sedative, such as diazepam (Valium), to prevent him
from scratching.
【正确答案】
C
【答案解析】Most clients can be discouraged from scratching if given a mild antihistamine, such as diphenhydramine, to relieve itching. Clients shouldn't scratch inside casts because of the risk of skin breakdown and potential damage to the cast. Sedatives aren't usually indicated for itching.