A nurse is assessing a client who is 2 days postoperative and is auscultating their bilateral breath sounds. The nurse notes absent breath sounds in the bases. The nurse should suspect which postoperative complication is occurring in this client?

Atelectasis

Pulmonary embolism

Arterial thrombus

Pneumonia

Answer and Explanation

The Correct Answer is A

Choice A Reason:

Atelectasis is a common postoperative complication, especially in patients who have undergone abdominal or thoracic surgery. It occurs when the alveoli in the lungs collapse, leading to reduced or absent breath sounds in the affected areas. This condition can result from shallow breathing, pain, or immobility after surgery. The absence of breath sounds in the bases of the lungs is a key indicator of atelectasis. Preventive measures include encouraging deep breathing exercises, using incentive spirometry, and early mobilization of the patient.

Choice B Reason:

Pulmonary embolism (PE) is a serious condition where a blood clot travels to the lungs, causing a blockage in one of the pulmonary arteries. While PE can present with symptoms such as sudden shortness of breath, chest pain, and rapid heart rate, it is less likely to cause absent breath sounds in the lung bases. Instead, PE may lead to decreased oxygen levels and respiratory distress. Diagnosis typically involves imaging studies such as a CT pulmonary angiography.

Choice C Reason:

Arterial thrombus refers to a blood clot that forms in an artery, which can lead to tissue ischemia and infarction. This condition is more commonly associated with cardiovascular events such as myocardial infarction or stroke. It does not typically present with absent breath sounds in the lungs. Instead, symptoms may include pain, pallor, and loss of function in the affected area. Diagnosis and treatment focus on restoring blood flow to the affected tissues.

Choice D Reason:

Pneumonia is an infection of the lungs that can cause symptoms such as cough, fever, and difficulty breathing. While pneumonia can lead to abnormal breath sounds, such as crackles or wheezes, it is less likely to cause completely absent breath sounds in the lung bases. Pneumonia is usually diagnosed through clinical examination, chest X-rays, and sputum cultures. Treatment involves antibiotics and supportive care to manage symptoms.

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Correct Answer is C

Explanation

Advance directives are legal documents that allow individuals to outline their preferences for medical treatment in case they become unable to communicate their decisions. These documents typically include a living will and a durable power of attorney for healthcare. The living will specifies the types of medical treatment a person wishes to receive or avoid, while the durable power of attorney for healthcare designates a trusted individual to make healthcare decisions on their behalf.

Choice A Reason:

“I will get my regular doctor to approve my plan before I hand it in to the hospital.”

This statement indicates a misunderstanding of the purpose of advance directives. While it is important to discuss your advance directives with your healthcare provider, the primary purpose of these documents is to communicate your wishes regarding medical treatment, not to seek approval from your doctor. The advance directive is a personal document that reflects your values and preferences for medical care.

Choice B Reason:

“I know they won’t go ahead with the surgery unless I prepare these forms.”

This statement also reflects a misunderstanding. While having advance directives in place is highly recommended, it is not typically a prerequisite for undergoing surgery. Advance directives are important for ensuring that your medical wishes are respected, but they are not mandatory for surgical procedures. The focus should be on making sure your wishes are known and documented, rather than on the necessity of the forms for surgery.

Choice C Reason:

“I plan to write that I do not want them to keep me on a breathing machine.”

This statement correctly reflects the purpose of an advance directive. It shows that the patient understands that they can specify their preferences for medical treatment, such as whether or not they want to be kept on a breathing machine. This type of instruction is a common component of a living will, which is part of an advance directive. It ensures that healthcare providers are aware of the patient’s wishes regarding life-sustaining treatments.

Choice D Reason:

“I would rather have my brother make decisions for me, but I know he has to be my wife.”

This statement is incorrect and confusing. It seems to mix up the roles of different individuals. In an advance directive, you can designate a healthcare proxy or durable power of attorney for healthcare, who can be any trusted person, not necessarily a spouse. The statement also contains a factual error, as it implies that the brother must be the patient’s wife, which is not possible. The correct understanding is that you can choose any trusted individual to make healthcare decisions on your behalf.

A. Asthma B. Hypertension C. Glaucoma D. Depression

Correct Answer is C

Explanation

Choice A: Asthma

Diphenhydramine is an antihistamine that can cause drying of the airways and thickening of bronchial secretions, which might exacerbate asthma symptoms. However, it is not strictly contraindicated in asthma patients. Instead, caution is advised, and it should be used under medical supervision if necessary.

Choice B: Hypertension

While diphenhydramine can cause mild increases in blood pressure due to its anticholinergic effects, it is not contraindicated in patients with hypertension. Patients with hypertension should use it cautiously and under medical advice, but it is not an absolute contraindication.

Choice C: Glaucoma

Diphenhydramine is contraindicated in patients with glaucoma, particularly closed-angle glaucoma. This is because diphenhydramine has anticholinergic properties that can increase intraocular pressure, potentially worsening the condition. Patients with glaucoma should avoid using diphenhydramine to prevent complications related to increased eye pressure.

Choice D: Depression

Diphenhydramine is not contraindicated in patients with depression. However, it can cause drowsiness and sedation, which might affect mood and energy levels. Patients with depression should use it cautiously and under medical supervision, but it is not an absolute contraindication.

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A nurse is assessing a client who is 2 days postoperative and is auscultating their bilateral breath sounds. The nurse notes absent breath sounds in the bases. The nurse should suspect which postoperative complication is occurring in this client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is giving preoperative instructions to a patient scheduled for surgery. The patient tells the nurse, “I will prepare my advance directives before I come to the hospital.” Which statement shows the client understands advance directives?

Correct Answer is C

Explanation

A client asks the nurse about a prescription for the antihistamine, diphenhydramine (Benadryl). The nurse should teach the client that this medication is contraindicated in clients who have a history of which condition?

Correct Answer is C

Explanation

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