A nurse is witnessing a client sign the consent form for surgery. After signing the consent form, the client starts asking questions regarding the risks and benefits of a surgical procedure. What action by the nurse is most appropriate?

Choice A reason: Vigorous bubbling in the water seal chamber indicates an air leak, suggesting a connection between the pleural space and atmosphere, possibly from a dislodged tube or lung tear. This worsens pneumothorax, requiring immediate intervention to locate and correct the leak, restoring pleural integrity and preventing respiratory compromise.

Choice B reason: Serosanguineous drainage less than 70 mL/hr is normal for a chest tube, indicating expected postoperative or pleural fluid drainage. It does not suggest complications like excessive bleeding or infection, so no immediate intervention is required, making this finding benign compared to an air leak.

Choice C reason: Mild chest discomfort during coughing or deep breathing is expected with a chest tube, as it irritates the pleural space. This does not indicate a complication requiring intervention, as it reflects normal tissue response to the tube, manageable with pain relief, not urgent action.

Choice D reason: Small crepitus around the insertion site indicates subcutaneous emphysema, where air escapes into tissues. While concerning, small amounts often resolve spontaneously as the lung heals. It requires monitoring but not immediate intervention, unlike vigorous bubbling, which signals a critical air leak requiring urgent action.

Choice A reason: Eating breakfast before surgery indicates a need for further teaching, as fasting (nothing by mouth) after midnight prevents aspiration during anesthesia. Food intake increases gastric contents, risking pulmonary complications, making this a critical misunderstanding requiring correction to ensure safe surgical preparation.

Choice B reason: Receiving an antibiotic preoperatively is standard to prevent surgical site infections, especially in high-risk procedures. This statement reflects correct understanding, as prophylactic antibiotics reduce bacterial load, minimizing postoperative infection risk, indicating no need for further teaching on this point.

Choice C reason: Refraining from smoking 8 hours before surgery is appropriate, as smoking increases airway reactivity and secretions, risking respiratory complications. This shows understanding, though longer cessation is ideal, making further teaching unnecessary for this specific preoperative instruction.

Choice D reason: Showering with Hibiclens (chlorhexidine) the morning of surgery is correct, as it reduces skin bacterial load, lowering infection risk. This statement reflects proper understanding of preoperative skin preparation, indicating no need for further teaching on this aspect of surgical preparation.