A patient started Alendronate (Fosamax) once a week for the treatment of osteoporosis. The nurse determines that further instruction about the drug is needed when what is said by the patient?

Choice A reason: Stating that skin organisms cannot infect a leg wound is incorrect, as skin flora, like Staphylococcus, can contaminate wounds, especially if hygiene is poor. This misunderstanding indicates ineffective teaching, as proper infection prevention emphasizes reducing bacterial transfer to wounds.

Choice B reason: Washing hands before changing a wound dressing is correct, as it removes pathogens, preventing contamination of the sterile field. Hand hygiene disrupts the transmission of bacteria like MRSA, reflecting effective infection prevention teaching and adherence to aseptic technique.

Choice C reason: Rinsing wound drainage down the kitchen sink is incorrect, as it risks environmental contamination with pathogens. Proper disposal involves biohazard protocols to prevent bacterial spread, indicating this statement reflects a misunderstanding of infection control principles.

Choice D reason: Removing wound dressings without gloves is incorrect, as gloves prevent pathogen transmission from contaminated dressings to the caregiver or environment. This statement shows a lack of understanding of standard precautions, indicating ineffective infection prevention teaching.

Choice A reason: Metabolic alkalosis and warm extremities are not typical of postoperative shock. Shock, often hypovolemic or septic post-surgery, causes hypotension and poor perfusion, leading to cool extremities and acidosis from tissue hypoxia. Alkalosis and warm extremities suggest other metabolic or circulatory conditions, not shock.

Choice B reason: Bradycardia and bradypnea are not primary features of postoperative shock. Hypovolemic or septic shock typically causes tachycardia and tachypnea as compensatory responses to reduced perfusion and oxygen delivery. These slowed vital signs suggest other conditions, like neurological issues, not shock.

Choice C reason: Hypertension and anuria are not characteristic of postoperative shock. Shock typically presents with hypotension due to reduced blood volume or vasodilation, and anuria may occur later but is not primary. Hypertension suggests other causes, like pain or fluid overload, not shock.

Choice D reason: Hypotension and confusion are hallmark signs of postoperative shock, often hypovolemic or septic. Hypotension results from reduced blood volume or vasodilation, impairing tissue perfusion, while confusion reflects cerebral hypoxia. These symptoms align with shock’s systemic impact on circulation and organ function.