Which of the following postoperative patients is at greatest risk for respiratory complications?

A 36-year-old male who had a minimally invasive appendectomy. The patient had community-acquired pneumonia a year ago.

A 58-year-old female with a history of type 1 diabetes. The patient had an incision and drainage of an abscess with procedural sedation.

A 19-year-old male having arthroscopic knee surgery under regional anesthesia. The patient has a history of exercise-induced asthma.

A 65-year-old female who has a BMI of 32 and a long history of tobacco use. The patient had upper abdominal surgery under general anesthesia.

Answer and Explanation

The Correct Answer is D

Choice A reason:

A 36-year-old male who had a minimally invasive appendectomy and a history of community-acquired pneumonia a year ago is at relatively low risk for postoperative respiratory complications. Minimally invasive surgeries typically have fewer complications, and a past episode of pneumonia does not significantly increase the risk unless there are ongoing respiratory issues.

Choice B reason:

A 58-year-old female with type 1 diabetes who had an incision and drainage of an abscess with procedural sedation has some risk factors for complications, such as diabetes, which can impair healing and immune response. However, the procedure was minor and performed under sedation, which poses less risk compared to general anesthesia.

Choice C reason:

A 19-year-old male undergoing arthroscopic knee surgery under regional anesthesia with a history of exercise-induced asthma has a low risk of respiratory complications. Regional anesthesia does not affect the respiratory system as much as general anesthesia, and exercise-induced asthma is generally well-controlled and less likely to cause complications in this context.

Choice D reason:

A 65-year-old female with a BMI of 32 and a long history of tobacco use who underwent upper abdominal surgery under general anesthesia is at the greatest risk for respiratory complications. Factors such as advanced age, obesity, smoking history, and the type of surgery (upper abdominal) significantly increase the risk of postoperative pulmonary complications. General anesthesia further exacerbates this risk due to its effects on respiratory function.

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Correct Answer is D

Explanation

Early signs of hypoxia, which is a condition where the body or a region of the body is deprived of adequate oxygen supply, often include symptoms such as restlessness, confusion, and tachycardia (rapid heart rate). These symptoms occur because the body is trying to compensate for the lack of oxygen by increasing heart rate and causing a state of agitation or confusion.

Choice A reason:

Bradycardia, lethargy, confusion are not typically early signs of hypoxia. Bradycardia (slow heart rate) is more commonly associated with severe or prolonged hypoxia rather than early stages. Lethargy and confusion can occur, but they are not as immediate as restlessness and tachycardia.

Choice B reason:

Hypotension, vomiting, cyanosis are also not early signs of hypoxia. Hypotension (low blood pressure) and cyanosis (bluish discoloration of the skin) are more advanced signs indicating severe hypoxia. Vomiting is not a common symptom of hypoxia and is more likely related to other conditions.

Choice C reason:

Bradycardia, dyspnea, cyanosis includes symptoms that are more indicative of advanced hypoxia. Dyspnea (difficulty breathing) and cyanosis are signs that the body has been deprived of oxygen for a longer period. Bradycardia is not an early sign and usually occurs later in the progression of hypoxia.

Choice D reason:

Restlessness, confusion, tachycardia are classic early signs of hypoxia. Restlessness and confusion occur due to the brain’s response to low oxygen levels, while tachycardia is the body’s attempt to increase oxygen delivery to tissues by pumping blood more rapidly. These symptoms are the body’s initial compensatory mechanisms to address the lack of oxygen.

A. “Try to go as long as possible before you press the button.” B. “Instruct your family or visitors to press the button for you when you are sleeping.” C. “Push the button every 15 minutes whether you feel pain at that time or not.” D. “Push the button when you begin to feel pain, instead of waiting until the pain becomes worse.”

Correct Answer is D

Explanation

Choice A reason:

Telling the patient to “try to go as long as possible before you press the button” is not advisable. PCA devices are designed to allow patients to manage their pain effectively by administering medication as soon as they begin to feel discomfort. Delaying the use of the PCA can lead to uncontrolled pain, which can be more difficult to manage later.

Choice B reason:

“Instruct your family or visitors to press the button for you when you are sleeping” is incorrect and potentially dangerous. Only the patient should press the PCA button to ensure that they are receiving the medication when they actually need it. Allowing others to press the button can lead to overmedication and serious side effects.

Choice C reason:

“Push the button every 15 minutes whether you feel pain at that time or not” is also incorrect. PCA devices are intended to be used on an as-needed basis. Pressing the button at regular intervals without experiencing pain can result in unnecessary medication administration and potential overdose.

Choice D reason:

“Push the button when you begin to feel pain, instead of waiting until the pain becomes worse” is the correct instruction. This approach helps to manage pain more effectively by preventing it from becoming severe. Early intervention with pain management can lead to better overall outcomes and patient comfort.

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Which of the following postoperative patients is at greatest risk for respiratory complications?

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Naxlex Comprehensive Predictor Exams

The nurse recognizes that the client is manifesting early signs of hypoxia with findings of:

Correct Answer is D

Explanation

What information would be important for the nurse to reinforce when teaching a pre-operative client about the correct use of the patient-controlled analgesia (PCA) device to achieve the best outcome?

Correct Answer is D

Explanation

The nurse is changing a client’s abdominal dressing and notes a separation of the incision line. The underlying tissue is protruding from the wound. The nurse should plan to do which of the following in the initial care of this wound?

Which is the best method for the nurse to correctly identify a client prior to surgery?

The nurse is planning the care of a client diagnosed with emphysema. The client is not currently reporting increased dyspnea, but the nurse has noted the client is anxious. Which nursing intervention(s) should be implemented?

Which nursing action should the nurse implement to prevent wound dehiscence in the postoperative client?

Which laboratory result of a preoperative client should the nurse report to the surgeon’s office, knowing that it could cause surgery to be postponed?

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The nurse is reviewing newly written prescriptions for a client diagnosed with acute bronchitis. The client has a productive cough with green sputum and shortness of breath. The nurse would question the primary care provider regarding which medication order?