A nurse is preparing to discharge an obese client after abdominal surgery. Which instruction should the nurse prioritize to promote wound healing and prevent complications?

You should avoid taking pain medication to prevent constipation

You should rest and avoid moving around too much to prevent strain on your incision

You may return to your normal activity level once you feel comfortable at home

It is important to maintain adequate nutrition, including a high-protein diet to support wound healing

Answer and Explanation

The Correct Answer is D

Choice A reason: Avoiding pain medication may increase discomfort, reducing mobility and increasing complications like atelectasis. Opioids can cause constipation, but this is managed with stool softeners, not avoidance. This statement is inaccurate, as pain control is essential for recovery and does not directly support wound healing.

Choice B reason: Excessive rest increases risks like venous thromboembolism or pneumonia, especially in obese patients. Early ambulation promotes circulation and wound healing without straining incisions if done cautiously. This statement is inaccurate, as limiting movement excessively hinders recovery and increases postoperative complications.

Choice C reason: Returning to normal activity too soon risks incision dehiscence or infection, particularly in obese patients with higher wound complication rates. Gradual activity increase under medical guidance is needed. This statement is inaccurate, as premature activity resumption can compromise healing and safety post-surgery.

Choice D reason: Adequate nutrition, especially high-protein intake, supports collagen synthesis and tissue repair, critical for wound healing. Obesity increases metabolic demand, and protein prevents malnutrition, enhancing immune response and incision strength. This statement is accurate, as nutrition is a priority to optimize postoperative recovery and prevent complications.

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Correct Answer is A

Explanation

Choice A reason: Insulin lispro, a rapid-acting insulin, peaks 1-2 hours after administration (around 8:30-9:30 am for a 7:30 am dose). This peak coincides with maximum glucose-lowering effect, increasing hypoglycemia risk, especially if breakfast is inadequate or delayed. This time is the most likely for low blood sugar due to insulin’s pharmacodynamics.

Choice B reason: At 7:45 am, insulin lispro is just beginning to act (onset 15-30 minutes), and breakfast is likely being consumed, providing glucose to counter insulin’s effect. Hypoglycemia risk is lower than at peak action (1-2 hours), making this time less critical for hypoglycemia monitoring.

Choice C reason: By 12:30 pm, insulin lispro’s effect (duration 3-5 hours) is waning, and glucose from breakfast is metabolized. Hypoglycemia risk is lower unless additional insulin or activity occurs. This time is less likely for hypoglycemia compared to the peak action period around 8:30 am.

Choice D reason: Tomorrow at 6:30 am is beyond insulin lispro’s duration of action (3-5 hours). Hypoglycemia risk from the 7:30 am dose is negligible 23 hours later, as insulin is cleared. This time is irrelevant to the dose’s effect, making it the least likely for hypoglycemia.

A. A 54-year-old male with bladder cancer B. A 65-year-old male with benign prostatic hyperplasia C. A 25-year-old female receiving chemotherapy for cancer D. A 36-year-old female with renal artery stenosis

Correct Answer is C

Explanation

Choice A reason: Bladder cancer primarily affects the bladder, causing hematuria or obstruction, leading to post-renal injury, not intra-renal. Intra-renal damage involves nephron injury, which is less likely with bladder cancer unless advanced metastasis affects kidneys, making this patient less at risk than one on nephrotoxic chemotherapy.

Choice B reason: Benign prostatic hyperplasia causes urinary obstruction, leading to post-renal kidney injury from backpressure, not intra-renal damage. The kidneys’ nephrons are not directly harmed by BPH, making this 65-year-old male less at risk for intra-renal injury compared to a patient receiving nephrotoxic drugs.

Choice C reason: Chemotherapy, especially agents like cisplatin, is nephrotoxic, causing intra-renal acute kidney injury by damaging renal tubules. This 25-year-old female faces high risk due to direct tubular toxicity, leading to acute tubular necrosis, making her the most likely to develop intra-renal injury among the options.

Choice D reason: Renal artery stenosis causes pre-renal kidney injury by reducing renal perfusion, not intra-renal damage. The nephrons remain intact unless chronic ischemia leads to secondary damage. This 36-year-old female has a lower risk of intra-renal injury compared to the chemotherapy patient’s direct nephrotoxic exposure.

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A nurse is preparing to discharge an obese client after abdominal surgery. Which instruction should the nurse prioritize to promote wound healing and prevent complications?

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Naxlex Comprehensive Predictor Exams

The client’s blood glucose level is 220 mg/dL. The client is about to eat breakfast. The prescribed sliding scale indicates that 4 units of insulin lispro (Humalog) be given subcutaneously at 7:30 am. At what time is the client most at risk for hypoglycemia?

Correct Answer is A

Explanation

Which client is at greatest risk of acute intra-renal kidney injury?

Correct Answer is C

Explanation

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