A client has just completed a bone marrow biopsy. What should the nurs

A client has just completed a bone marrow biopsy. What should the nurse document about the client at this time?

1. Client’s tolerance of the procedure
2. Bowel sounds
3. The site for bleeding
4. Status of deep tendon reflexes
5. Presence of pain and any pain medication received

ANSWER

Correct Answer: 1, 3, 5
Rationale 1: The nurse should document how well the client tolerated the procedure, as it can cause considerable discomfort.
Rationale 2: Bowel sounds are not a part of the assessment after a bone marrow biopsy.
Rationale 3: The nurse should document the bone marrow biopsy site for bleeding, as this can occur.
Rationale 4: Deep tendon reflexes are not part of the assessment after a bone marrow biopsy.
Rationale 5: The nurse should document whether the client is experiencing any pain, and whether any pain medication was provided.