A nurse is reinforcing preoperative teaching with a client who is to undergo a bowel resection at 1300 next week. Which of the following statements client indicates to the nurse a need for further teaching?

A. Data collection:

Data collection is the initial step of the nursing process where the nurse gathers information about the client's health status, including physical, psychological, sociocultural, and spiritual factors. While data collection is essential for planning, in this scenario, the nurse is already involved in the collaborative process of preparing a discharge plan, indicating the phase of planning.

B. Planning:

Planning involves developing a comprehensive plan of care based on the assessment data collected. It includes setting priorities, establishing goals, identifying interventions, and coordinating resources to meet the client's needs. In this scenario, the nurse, social worker, and physical therapist are working together to plan the client's discharge, which involves determining the appropriate support, resources, and interventions needed for a successful transition.

C. Evaluation:

Evaluation occurs after implementation, where the nurse assesses the client's response to the interventions implemented and determines whether the goals and outcomes have been achieved. While evaluation is an essential part of the nursing process, it occurs after planning and implementation.

D. Implementation:

Implementation involves carrying out the plan of care developed during the planning phase. It includes initiating interventions, providing treatments, and coordinating care to meet the client's needs. In this scenario, the nurse, social worker, and physical therapist are in the process of developing the discharge plan, which precedes implementation.

Answer: C. Respiratory acidosis

Rationale:

A) Metabolic acidosis: This occurs when there is an excess of acid in the body or a loss of bicarbonate, often due to conditions such as renal failure or severe diarrhea. In chronic bronchitis, the primary issue is related to respiratory function rather than metabolic disturbances.

B) Respiratory alkalosis: This condition results from hyperventilation, leading to excessive loss of carbon dioxide. It is unlikely in a client with chronic bronchitis, who typically experiences difficulty in exhaling fully rather than hyperventilating.

C) Respiratory acidosis: In chronic bronchitis, airflow obstruction and reduced gas exchange can lead to carbon dioxide retention, resulting in respiratory acidosis. Symptoms like dyspnea and increased work of breathing support this imbalance, as the body is unable to adequately expel carbon dioxide.

D) Metabolic alkalosis: This imbalance results from excessive bicarbonate or loss of hydrogen ions, often related to prolonged vomiting or diuretics. It is not characteristic of chronic bronchitis, where the primary concern is respiratory function rather than metabolic processes.