A nurse is assisting with a preoperative teaching plan for a client. Which of the following actions should the nurse include in the plan?

Provide educational material written at an eighth-grade reading level

Ensure privacy for the client.

Start with the least important information.

Dim the lights in the client's room.

Answer and Explanation

The Correct Answer is A

A. Provide educational material written at an eighth-grade reading level: This is correct. Health education materials should be written at a level that is easily understandable by the majority of patients. An eighth-grade reading level is often recommended to ensure that the information is accessible to a wide range of patients.

B. Ensure privacy for the client: This is also correct. Privacy is a fundamental right of all patients and is particularly important when discussing sensitive topics such as preoperative care. Ensuring privacy can help the patient feel more comfortable and facilitate open communication.

C. Start with the least important information: This is not recommended. When providing education, it’s generally best to start with the most important information. Patients may be anxious or overwhelmed, and they may not remember everything that is discussed. By starting with the most important information, you increase the chances that the patient will remember and understand the key points.

D. Dim the lights in the client’s room: While creating a comfortable environment is important, dimming the lights is not specifically related to preoperative teaching. The focus should be on providing clear, understandable information and addressing the patient’s questions and concerns.

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Correct Answer is D

Explanation

(A) Respiratory acidosis: Respiratory acidosis is characterized by a low pH (<7.35) and a high PaCO2 (>45 mm Hg). In this case, the client’s pH is high and PaCO2 is normal, which rules out respiratory acidosis.

(B) Respiratory alkalosis: Respiratory alkalosis is characterized by a high pH (>7.45) and a low PaCO2 (<35 mm Hg). Although the client’s pH is high, the PaCO2 is normal, which rules out respiratory alkalosis.

(C) Metabolic acidosis: Metabolic acidosis is characterized by a low pH (<7.35) and a low bicarbonate level (<22 mEq/L). The client’s pH and bicarbonate levels are both high, which rules out metabolic acidosis.

(D) Metabolic alkalosis: Metabolic alkalosis is characterized by a high pH (>7.45) and a high bicarbonate level (>26 mEq/L). The client’s pH is 7.6 and bicarbonate level is 32 mEq/L, both of which are higher than normal. This indicates metabolic alkalosis. Therefore, the nurse should identify that the client is experiencing metabolic alkalosis.

A. Heart murmur B. Clubbing of the fingers C. Bradycardia D. Barrel chest

Correct Answer is A

Explanation

(A) Heart murmur: This is the most appropriate answer. Mitral valve stenosis can cause a heart murmur due to turbulent blood flow across the narrowed mitral valve. This is often heard best at the apex of the heart with the patient in the left lateral decubitus position.

(B) Clubbing of the fingers: Clubbing of the fingers is typically associated with conditions that cause chronic hypoxia, such as lung disease or congenital heart disease. It is not a common finding in mitral valve stenosis.

(C) Bradycardia: Mitral valve stenosis does not typically cause bradycardia. In fact, some patients may have a rapid heart rate (tachycardia) due to atrial fibrillation, which is a common complication of mitral valve stenosis.

(D) Barrel chest: A barrel chest is typically associated with chronic obstructive pulmonary disease (COPD) and is not a common finding in mitral valve stenosis. It refers to a rounded, bulging chest that resembles the shape of a barrel. This occurs due to overinflation of the lungs over a long period of time.

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A nurse is assisting with a preoperative teaching plan for a client. Which of the following actions should the nurse include in the plan?

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