A post-operative patient is at risk for developing a wound infection. Which of the following nursing assessments is the highest priority to prevent this complication?

Monitoring the patient's vital signs

Assessing the patient's pain level

Inspecting the surgical incision site for redness, swelling

Assessing the patient's fluid intake and output

Answer and Explanation

The Correct Answer is C

A.   While important for overall patient assessment, it's not the most direct way to monitor for a wound infection.
B.   Pain can indicate a wound infection, but it's not as specific as directly inspecting the wound.
C.   This is the most direct way to assess for early signs of a wound infection. Redness, swelling, warmth, and drainage are classic signs of infection.
D.   Important for overall patient care, but not specifically related to wound infection prevention.

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Correct Answer is B

Explanation

A. Deep breathing exercises should be performed regularly, regardless of the level of pain. The exercises are crucial for preventing lung complications, and pain management should be addressed so that the client can perform these exercises effectively.
B. This statement reflects a proper understanding of the importance of regular deep breathing exercises. Performing these exercises every hour while awake helps to keep the alveoli open and reduces the risk of atelectasis and pneumonia. Consistent practice is essential for maximizing lung expansion and preventing complications.
C. Coughing exercises should be performed regularly, not just when experiencing shortness of breath. Coughing helps to clear secretions from the airways and prevent their accumulation, which can lead to respiratory infections and other complications.
D. Avoiding deep breathing exercises is not advisable. While there may be some discomfort, deep breathing is essential for lung health post-operatively. The exercises help prevent complications such as atelectasis.

A. Sending a follow-up survey via email to assess the client's satisfaction with the teaching provided B. Asking the client if they have any questions or concerns about their home care instructions C. Asking the client to demonstrate the proper technique for dressing their surgical incision D. Reviewing the client's vital signs to ensure they are within normal limits.

Correct Answer is C

Explanation

A. This is a good method to gather feedback but does not directly assess the client's ability to perform the taught skills.
B. This is important to identify knowledge gaps but does not assess the client's ability to perform the skills.
C. This is the most direct way to assess the client's ability to perform the taught skill and ensures that the client has retained the information.
D. While important, vital signs do not directly assess the effectiveness of home care teaching.

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A post-operative patient is at risk for developing a wound infection. Which of the following nursing assessments is the highest priority to prevent this complication?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse emphasizes the importance of deep breathing and coughing exercises post-operatively to prevent complications. Which statement by the client indicates understanding of these exercises?

Correct Answer is B

Explanation

Which of the following is an appropriate evaluation method to assess the effectiveness of home care teaching after a client has surgery?

Correct Answer is C

Explanation

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