A nurse is teaching a client with rheumatoid arthritis who has a new prescription for oral glucocorticoid therapy. Which client statement indicates understanding of the teaching?

A.Teaching the client to practice deep breathing exercises is a preventive measure for respiratory complications but is completely inappropriate during an acute evisceration. Increased intra-abdominal pressure from deep breathing or coughing can further expel visceral organs through the surgical dehiscence. At this stage, the nurse must prioritize immediate surgical emergency protocols rather than routine postoperative education or respiratory hygiene.

B.Placing the client in a supine position with the hips and knees flexed reduces tension on the abdominal musculature and the surgical incision site. This specific positioning helps prevent further protrusion of the viscera by relaxing the abdominal wall and lowering intra-abdominal pressure. It is a critical first-aid intervention to stabilize the client while preparing for emergency surgical repair of the wound.

C.Covering the wound with a dry, adherent dressing is strictly contraindicated because it causes the delicate serosal surface of the protruding organs to stick to the gauze. This can lead to tissue trauma, ischemia, and necrosis when the dressing is eventually removed. The nurse should instead apply a sterile, non-adherent dressing moistened with warmed 0.9% sodium chloride to maintain tissue viability and moisture.

D.Carefully reinserting the intestines through the wound opening is an action that must never be performed by a nurse as it increases the risk of infection and organ injury. Attempting to push the viscera back into the peritoneal cavity can cause intestinal perforation or introduce pathogens into a sterile environment. The nurse's role is to protect the exposed tissue and keep it moist until a surgeon can perform the repair.

A.Current clinical guidelines recommend a Tdap or Td booster every 10 years for adults to maintain immunity against tetanus and diphtheria. Since this 66-year-old client received their last dose only 8 years ago, they are currently up to date and do not require immediate intervention. Their status is appropriate according to standard preventative health schedules for the geriatric population.

B.It is standard practice for older adults to receive both the pneumococcal conjugate vaccine (PCV15 or PCV20) and the pneumococcal polysaccharide vaccine (PPSV23) to prevent streptococcal pneumonia. This 70-year-old client has completed the recommended series, providing them with broad protection against common bacterial respiratory pathogens. No further education or intervention is required for this specific vaccination category at this time.

C.The live attenuated influenza vaccine (LAIV) is contraindicated in individuals aged 50 years and older due to age-related changes in the immune system and a higher risk of adverse effects. Adults in this age group should receive the inactivated influenza vaccine (IIV) or the recombinant influenza vaccine (RIV). The nurse must intervene to ensure the client receives the safer, age-appropriate inactivated formulation.

D.The recombinant zoster vaccine (Shingrix) is recommended for all healthy adults aged 50 years and older, regardless of whether they had a prior shingles episode or received the older live vaccine. This 58-year-old client is eligible for the two-dose series and should be educated on its importance for preventing herpes zoster. The nurse's intervention is necessary to protect the client from painful nerve-related complications.