To ensure client adherence to the postoperative regimen, which content is most important for the nurse to include in the preoperative teaching?

"You will feel drowsy for several hours after surgery."

"You will need to get out of bed the day after surgery."

"Your clear liquid diet will include gelatine and tea."

"Your bowel sounds will be assessed every four hours."

Answer and Explanation

The Correct Answer is B

Choice A reason: Informing the client that they will feel drowsy for several hours after surgery is important for setting realistic expectations about the immediate postoperative period. However, it is not the most critical information to ensure adherence to the postoperative regimen.

Choice B reason: It is essential to inform the client about the importance of early mobilization, which involves getting out of bed the day after surgery. Early mobilization helps prevent complications such as deep vein thrombosis (DVT), pulmonary embolism, and pneumonia. Emphasizing this information preoperatively ensures that the client understands the necessity of moving and participating in their recovery process, which is vital for successful postoperative outcomes.

Choice C reason: Explaining the components of a clear liquid diet, including gelatine and tea, is helpful for the client to know what to expect in terms of dietary modifications. However, it is not as critical as informing the client about early mobilization, which has a direct impact on their recovery and prevention of complications.

Choice D reason: Informing the client that their bowel sounds will be assessed every four hours is part of routine postoperative care. While it is important for the client to understand the monitoring process, it is not the most crucial aspect to ensure adherence to the postoperative regimen. Early mobilization has a more significant impact on the client’s overall recovery.

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Correct Answer is A

Explanation

Choice A reason: Determining if the client has a sliding scale insulin prescription is crucial. A sliding scale insulin regimen can help manage elevated blood glucose levels effectively. In the case of a capillary glucose of 365 mg/dL, prompt intervention is needed to prevent hyperglycaemia-related complications, and insulin administration is the most appropriate immediate action.

Choice B reason: Stopping the infusion until the healthcare provider is notified may not be the best immediate action. While it is essential to address the hyperglycaemia, halting the parenteral nutrition infusion can affect the client's overall nutritional and fluid balance. The focus should be on managing the glucose levels promptly.

Choice C reason: Assessing the client's urinary output for the previous 24 hours is important for monitoring overall fluid status and kidney function, but it does not directly address the immediate need to manage the elevated glucose levels.

Choice D reason: Reviewing the client's record for a history of diabetes mellitus can provide valuable information for long-term management and understanding the client's baseline glucose control. However, it is not the most urgent action in response to an acutely elevated capillary glucose level. Immediate intervention with insulin is needed to address the hyperglycaemia.

A. Crackles or coarse rales. B. Pleural friction rub. C. Low pitched, sonorous rhonchi. D. Diminished breath sounds.

Correct Answer is D

Explanation

Choice A reason: Crackles or coarse rales are typically associated with fluid in the airways, such as in cases of congestive heart failure or pneumonia, but they do not directly indicate a pleural effusion.

Choice B reason: A pleural friction rub is associated with pleuritis, where the inflamed pleurae rub against each other. It does not indicate decreased air flow in a specific lobe.

Choice C reason: Low pitched, sonorous rhonchi are related to secretions in the larger airways and are not specific to a pleural effusion or decreased air flow in one lobe.

Choice D reason: Diminished breath sounds in the left upper lobe are consistent with a pleural effusion, as the fluid can reduce air flow and sound transmission in that area. This finding directly correlates with the x-ray results showing decreased air flow in the entire left upper lobe.

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To ensure client adherence to the postoperative regimen, which content is most important for the nurse to include in the preoperative teaching?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The practical nurse (PN) reports to the charge nurse that a client who is receiving a parenteral nutrition infusion has a capillary glucose of 365 mg/dL (20.3 mmol/L). Which action should the charge nurse implement?

Correct Answer is A

Explanation

The chest x-ray for a client who is admitted for pneumonia shows a pleural effusion with decreased air flow in the entire left upper lobe. After auscultating the left upper lobe, which breath sounds documented by the nurse verify the x-ray findings?

Correct Answer is D

Explanation

A client with a history of diabetes mellitus and hypertension received new medication prescriptions three days ago. Today the client returns to the clinic reporting a severe headache and blurred vision. Which intervention should the nurse implement first?

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