A nurse is providing preoperative teaching for a patient who is scheduled for a gastrectomy.
Which of the following information regarding the prevention of postoperative complications should the nurse include in the teaching?
Teach the client how to use the PCA pump.
Instruct the client on coughing and deep breathing exercises.
Explain the importance of early ambulation.
Discuss the use of incentive spirometry.
Correct Answer : B,C,D
Choice A rationale
While pain management is crucial postoperatively, teaching the client how to use a PCA pump does not directly prevent common postoperative complications like pneumonia, deep vein thrombosis, or wound infections. These complications are more directly addressed by respiratory exercises and early mobilization.
Choice B rationale
Instructing the client on coughing and deep breathing exercises is essential for preventing postoperative pulmonary complications such as atelectasis and pneumonia. These exercises help to expand the lungs, mobilize secretions, and improve oxygenation, reducing the risk of infection and respiratory distress.
Choice C rationale
Explaining the importance of early ambulation is vital in preventing several postoperative complications. Mobilization improves circulation, reducing the risk of deep vein thrombosis and pulmonary embolism. It also helps to promote bowel function and prevent constipation, as well as aiding in lung expansion and preventing atelectasis.
Choice D rationale
Discussing the use of incentive spirometry is important for preventing postoperative respiratory complications. Incentive spirometry encourages deep and sustained inhalation, which helps to expand the alveoli, improve lung volume, and prevent atelectasis and pneumonia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Insertion of a nasogastric tube is expected in a client with paralytic ileus to decompress the bowel by removing accumulated fluids and gas. Paralytic ileus is a non-mechanical obstruction of the bowel characterized by a lack of peristalsis, often occurring after abdominal surgery like an appendectomy. This decompression helps relieve abdominal distension, pain, and nausea, facilitating the return of bowel function.
Choice B rationale
Providing a bulk-forming agent, such as psyllium, is contraindicated in paralytic ileus. Bulk-forming agents work by increasing the volume of stool, which would exacerbate the obstruction and potentially cause further discomfort and complications in the absence of peristalsis. These agents are typically used to treat constipation by adding fiber to the diet and promoting bowel movements.
Choice C rationale
Administering an antacid, such as aluminum hydroxide or calcium carbonate, is not a primary intervention for paralytic ileus. Antacids work by neutralizing stomach acid and are used to treat conditions like heartburn and acid reflux. While a client with paralytic ileus might experience some gastric upset, the underlying issue is the lack of bowel motility, which antacids do not address.
Choice D rationale
Applying a truss is used to provide support for hernias, a condition unrelated to paralytic ileus following an appendectomy. A truss helps to keep the protruding tissue in place and reduce discomfort associated with the hernia. It does not address the underlying lack of bowel motility characteristic of paralytic ileus.
Correct Answer is C
Explanation
Choice A rationale
Checking blood glucose levels for hypoglycemia once yearly is insufficient for a patient taking high doses of oral glucocorticoids for an extended period. Glucocorticoids can cause hyperglycemia by increasing gluconeogenesis and insulin resistance. Therefore, blood glucose monitoring should be more frequent, especially when initiating or adjusting the dosage. Normal fasting blood glucose levels are typically 70-99 mg/dL.
Choice B rationale
Limiting the intake of calcium-rich foods is incorrect advice for a patient on long-term glucocorticoid therapy. Glucocorticoids can decrease calcium absorption from the gut and increase bone resorption, leading to osteoporosis. Therefore, patients on these medications should be encouraged to maintain an adequate intake of calcium and vitamin D to help preserve bone density. Normal total serum calcium levels range from 8.6 to 10.2 mg/dL.
Choice C rationale
Monitoring for fractures over the next several months is an important instruction for a patient taking high doses of oral glucocorticoids long-term. Glucocorticoids increase the risk of osteoporosis and subsequent fractures, particularly vertebral compression fractures and hip fractures, due to their effects on bone metabolism. Regular monitoring and preventive measures are crucial.
Choice D rationale
Glucocorticoids do not boost immunity; instead, they suppress the immune system by inhibiting the production and function of various immune cells and inflammatory mediators. This immunosuppressive effect is why they are used to treat autoimmune diseases like rheumatoid arthritis, but it also increases the risk of infections.
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