When providing preoperative care for a client with an abdominal aneurysm, changes in which assessment finding are most important for the practical nurse (PN) to report to the registered nurse (RN)?

Choice A reason: Impaired communication can be a concern for clients with Guillain-Barré syndrome (GBS), especially if they experience facial weakness or difficulty speaking. This can impact their ability to express needs and interact with caregivers, potentially leading to frustration and miscommunication. Although it's important to address communication issues, it is not the highest priority compared to the risk of respiratory compromise due to ascending paralysis, which can be life-threatening.
Choice B reason: Ascending paralysis is the most critical problem to address in clients with GBS. This condition can lead to progressive muscle weakness that starts in the lower extremities and moves upward, potentially affecting the respiratory muscles. Respiratory failure is a life-threatening complication of GBS, and monitoring for signs of ascending paralysis is essential to ensure timely intervention and support, such as mechanical ventilation if needed. Early detection and management of ascending paralysis can significantly impact the client's prognosis and overall outcome.
Choice C reason: Fear and anxiety are common in clients with GBS due to the sudden onset and potential severity of the condition. While addressing emotional well-being is important, it is not the highest priority compared to the risk of respiratory compromise. Providing emotional support and reassurance can help alleviate anxiety and improve the client's overall experience. However, the primary focus should be on monitoring and managing physical symptoms, particularly those that pose an immediate threat to the client's life.
Choice D reason: Immobility can result from muscle weakness and paralysis in clients with GBS. Prolonged immobility can lead to complications such as pressure ulcers, deep vein thrombosis (DVT), and muscle atrophy. While it is important to prevent and manage these complications through interventions like physical therapy and repositioning, the immediate priority is to monitor for ascending paralysis and ensure adequate respiratory function. Once the client's respiratory status is stable, comprehensive care can include addressing immobility-related issues.

Choice A reason: Smoking two packs of cigarettes a day is highly significant in planning the client's rehabilitation following a myocardial infarction. Smoking is a major risk factor for cardiovascular disease, and continuing to smoke can significantly hinder recovery and increase the risk of future cardiac events. Addressing this behavior is crucial for improving the client's long-term health outcomes. Smoking cessation should be a primary focus of the rehabilitation plan, and the client should be provided with resources and support to quit smoking, such as counseling, nicotine replacement therapy, or medications.
Choice B reason: Expressing a desire to change one's lifestyle is a positive and encouraging sign. It indicates the client's motivation to adopt healthier habits, which is essential for successful rehabilitation. However, while this is important, the immediate focus should be on addressing specific risk factors, such as smoking, that have a direct and significant impact on the client's recovery and future health. The desire to change is a valuable component of the rehabilitation process, but it should be coupled with targeted interventions to address critical behaviors like smoking.
Choice C reason: Drinking 1 to 2 glasses of red wine daily may have both positive and negative health implications. Moderate alcohol consumption has been suggested to have some cardiovascular benefits, but it can also pose risks, especially if not monitored. While this information is relevant to the client's overall lifestyle, it is not as immediately critical as addressing smoking, which has a well-documented and direct impact on cardiovascular health. The client's alcohol consumption can be discussed as part of the broader lifestyle changes during rehabilitation.
Choice D reason: Walking four city blocks to work each day indicates a level of physical activity that is beneficial for cardiovascular health. Encouraging regular physical activity is an essential part of the rehabilitation process. However, compared to the impact of smoking, this information is less critical in the immediate planning of the client's rehabilitation. The focus should be on eliminating harmful behaviors like smoking, while also promoting continued and possibly increased physical activity as part of a comprehensive rehabilitation plan.