The nurse is caring for a client with a new diagnosis of epilepsy who is prescribed phenytoin. Which teaching point should the nurse emphasize?

Choice A reason: Obtaining an arterial blood gas assesses oxygenation and acid-base status, useful in COPD management, but is not required before postural drainage. This invasive procedure is unnecessary for routine drainage, which mobilizes secretions. Explaining positions prepares the client, enhancing cooperation and effectiveness.

Choice B reason: Performing drainage after meals risks aspiration or vomiting, as a full stomach increases intra-abdominal pressure in COPD patients. Postural drainage is most effective when performed on an empty stomach, making this approach incorrect. Patient education on positioning is the priority.

Choice C reason: Shallow, fast breathing is counterproductive in COPD, as it reduces tidal volume and worsens hypercapnia. Postural drainage requires slow, deep breaths to mobilize secretions and improve ventilation. Explaining positions ensures proper technique, making this breathing instruction incorrect.

Choice D reason: Explaining that the client may be placed in five positions (e.g., prone, supine, lateral) prepares them for postural drainage, which uses gravity to mobilize lung secretions in COPD. This education enhances compliance and effectiveness, as proper positioning is critical for therapeutic success, making it the correct approach.

Choice A reason: Hepatorenal failure involves liver and kidney dysfunction, typically from chronic liver disease or shock. Elevated amylase and lipase, with pain and vomiting, point to pancreatic inflammation, not hepatorenal issues. Pancreatitis is more consistent with the client’s post-cholecystectomy presentation and lab findings.

Choice B reason: Biliary duct obstruction causes jaundice and elevated bilirubin, not amylase or lipase. Pain may radiate, but vomiting and fever with high pancreatic enzymes suggest pancreatitis, a known post-cholecystectomy complication, rather than a blocked bile duct, which lacks pancreatic enzyme elevation.

Choice C reason: Surgical site infection causes localized pain, erythema, and fever but not elevated amylase or lipase. Radiating pain and vomiting align with pancreatitis, not wound infection. Pancreatic enzyme elevation is specific to pancreatic inflammation, making infection less likely than pancreatitis in this scenario.

Choice D reason: Acute pancreatitis is characterized by elevated amylase and lipase, epigastric pain radiating to the back, vomiting, and fever. Post-cholecystectomy, bile duct manipulation or gallstone migration can trigger pancreatitis. These findings align perfectly with the client’s symptoms and lab results, making it the correct condition.