The nurse is caring for a patient preparing for surgery. Which finding would concern the nurse?

Positive pregnancy test

Family history of hypertension

Signed advance directive

Medical history of diabetes

Answer and Explanation

The Correct Answer is A

Choice A reason: A positive pregnancy test is a significant concern for a patient preparing for surgery as it can affect the type of anesthesia used and the surgical approach, due to the potential impact on the fetus.

Choice B reason: While a family history of hypertension is important, it is not as immediately concerning as a positive pregnancy test in a patient preparing for surgery.

Choice C reason: A signed advance directive is a document that outlines a patient's wishes regarding medical treatment and is not a concern but rather a part of preoperative preparation.

Choice D reason: A medical history of diabetes is important to consider in surgical patients due to potential complications with wound healing and blood glucose control, but it is not as urgent as confirming pregnancy status before surgery.

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Correct Answer is C

Explanation

Choice A reason: While limit-setting is important, it should not be overly strict as it can increase anxiety in patients who are already highly anxious.

Choice B reason: Increasing environmental stimuli may overwhelm a highly anxious patient rather than help them.

Choice C reason: Providing support and a therapeutic milieu offers a safe and structured environment, which can help reduce anxiety and promote healing.

Choice D reason: More freedom can be beneficial, but it must be balanced with the need for a supportive and structured environment for a highly anxious patient.

A. "I start to use the incentive spirometer when I can get out of bed." B. "I breathe deeply and cough every 4 hours." C. "I splint my incision with a pillow to cough." D. "I lie flat in bed to cough and deep breathe."

Correct Answer is C

Explanation

Choice A reason: Using the incentive spirometer is important, but it is not specifically related to deep breathing and coughing exercises.

Choice B reason: Breathing deeply and coughing every 4 hours is part of postoperative care, but it does not indicate understanding of the technique to protect the incision.

Choice C reason: Splinting the incision with a pillow while coughing is a recommended technique to support the incision and reduce pain during coughing, indicating an understanding of the instructions.

Choice D reason: Lying flat is not recommended for deep breathing and coughing exercises as it can inhibit lung expansion and is not conducive to effective coughing.

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The nurse is caring for a patient preparing for surgery. Which finding would concern the nurse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which of the following is a priority when caring for a highly anxious patient?

Correct Answer is C

Explanation

A nurse is reinforcing teaching with a client who is preoperative following abdominal surgery about deep breathing and coughing exercises. Which of the following client statements should indicate to the nurse an understanding of the instructions?

Correct Answer is C

Explanation

The nurse is caring for a client on the third day following abdominal surgery and assesses the absence of bowel sounds, abdominal distention, and the client passing no flatus. These findings indicate the client is experiencing which of the following postoperative complications?

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