A nurse has conducted preoperative teaching for a client scheduled for surgery in one week. Which statement by the client indicates a need for further teaching?

Choice A reason: Air embolism occurs when air enters the bloodstream, not from vesicant extravasation. Vesicants, like chemotherapy drugs, cause local tissue damage when leaking outside the vein, leading to necrosis, not vascular occlusion, making air embolism an incorrect complication in this context.

Choice B reason: Tissue necrosis is a primary complication of vesicant extravasation, as these medications (e.g., chemotherapy agents) are toxic to tissues outside the vein. Leakage causes severe damage, leading to cell death, ulceration, and potential tissue loss, making this the critical complication to identify and manage.

Choice C reason: Edema may occur with extravasation due to fluid leakage but is not the primary concern with vesicants. Vesicant extravasation causes severe tissue damage, leading to necrosis rather than just swelling, making edema a less specific and severe complication in this scenario.

Choice D reason: Thrombus formation is a risk with intravenous catheters but not a direct result of vesicant extravasation. Vesicants cause chemical damage to tissues, leading to necrosis, not clot formation, making thrombus an incorrect choice for vesicant extravasation’s primary effect.

Choice A reason: A 30-pack-year smoking history indicates COPD risk but not acute distress. Smoking is a chronic factor, not an immediate symptom requiring urgent assessment. Clients with active respiratory distress, like accessory muscle use, take priority due to immediate risks of hypoxia.

Choice B reason: A 52-year-old in a tripod position using accessory muscles indicates severe respiratory distress in COPD, reflecting hypoxia or hypercapnia. This posture and muscle use signal increased work of breathing, requiring immediate assessment to prevent respiratory failure, making this client the highest priority.

Choice C reason: Dependent edema and clubbed fingers in a 68-year-old suggest chronic COPD with possible cor pulmonale. These are chronic findings, not acute distress. Clients with immediate respiratory compromise, like accessory muscle use, take priority due to the risk of rapid decompensation.

Choice D reason: Chronic cough with thick secretions is common in COPD but less urgent than acute respiratory distress. Secretions contribute to airway obstruction, but tripod positioning and accessory muscle use indicate immediate hypoxia risk, requiring priority assessment over chronic symptoms.