A nurse is reviewing the medical history of a client who is luted for surgery. Which of the following findings places the client at risk for a complication of incisional hematoma forming?

A) The client who has a nasogastric (NG) tube to suction:
A nasogastric (NG) tube that is used for suction can lead to the loss of gastric fluids, which are rich in potassium. Prolonged suctioning can cause the client to lose significant amounts of potassium, putting them at risk for hypokalemia. Potassium is an essential electrolyte that is vital for proper muscle and nerve function, and its loss can result in symptoms such as weakness, arrhythmias, and fatigue.

B) The client who has a chest tube to water seal:
A chest tube to water seal is used to drain air or fluid from the pleural space, typically following surgery or trauma. While chest tube drainage can lead to fluid loss, it is not directly associated with significant electrolyte imbalances like hypokalemia. The primary concern with chest tubes is fluid balance and preventing infection, but it does not specifically cause potassium loss unless there are other contributing factors, such as excessive diuresis or vomiting.

C) The client who has an indwelling urinary catheter to gravity drainage:
An indwelling urinary catheter primarily allows for the drainage of urine, and while it may contribute to fluid and electrolyte loss (especially if there is excessive urination or diuresis), it is not directly linked to hypokalemia unless the client is receiving medications (e.g., diuretics) that cause potassium loss through urine. The catheter itself does not significantly increase the risk of hypokalemia unless other factors are involved.

D) The client who has a tracheostomy tube attached to humidified oxygen:
A tracheostomy tube attached to humidified oxygen helps with respiratory support and does not directly affect potassium levels. The primary concern with tracheostomies is airway management, preventing infection, and ensuring proper oxygenation. It is not associated with electrolyte imbalances such as hypokalemia. However, if the client experiences issues such as excessive fluid loss through respiratory secretions or complications like infection, it could indirectly affect electrolyte levels, but it is not a direct cause of hypokalemia.

A) Use the provider’s initials after the prescription:
Using the provider's initials after the prescription is not an appropriate or standard practice. The nurse should transcribe the prescription accurately and include the provider's full name or identification, but not initials. The nurse is responsible for ensuring the correct interpretation and transmission of the order, and abbreviations or initials could lead to errors or confusion.

B) Repeat the prescription to the provider:
Repeating the prescription to the provider may not be sufficient. It is important to read the prescription back to the provider to ensure that both the nurse and the provider are in agreement about the medication order. Repeating the prescription is a good practice, but it does not provide the same level of verification as reading it back to ensure its accuracy.

C) Write the prescription in shorthand:
Writing prescriptions in shorthand is unsafe and should be avoided. Shorthand can lead to misunderstandings or misinterpretations of the order, which could result in medication errors. The nurse should transcribe the prescription clearly and in full, without using any abbreviations or shorthand, to ensure clarity and accuracy.

D) Read back the prescription to the provider:
Reading back the prescription to the provider is the correct action. This practice, often referred to as "read-back," helps to confirm that the nurse has accurately heard and understood the provider’s order. It is a safety measure that reduces the likelihood of medication errors, especially in high-risk situations like verbal or telephone orders. The nurse should repeat the prescription verbatim, including dosage, route, frequency, and any other relevant details, to ensure it has been transcribed correctly.