The nurse is caring for a patient undergoing surgery with the nursing diagnosis of deficient knowledge related to lack of previous surgical experience. Which nursing intervention is appropriate? (Select all that apply.)

Tell them everything will be okay.

Include family members in teaching.

Identify knowledge deficiencies.

Provide the patient with written and verbal materials.

Determine the patient's anxiety levels.

Document patient understanding and teaching provided.

Answer and Explanation

Correct Answer : B,C,D,E,F

Choice A reason: Telling the patient everything will be okay is not an appropriate intervention as it does not address the specific educational needs related to their knowledge deficit.

Choice B reason: Including family members in teaching can provide additional support and help reinforce the information provided to the patient.

Choice C reason: Identifying knowledge deficiencies is essential to tailor the education to the patient's specific needs.

Choice D reason: Providing written and verbal materials can help the patient understand and remember the information about their surgery and care.

Choice E reason: Determining the patient's anxiety levels can help the nurse address any concerns or fears that may affect their learning.

Choice F reason: Documenting patient understanding and teaching provided is important for continuity of care and to ensure that the patient has received and understood the necessary information.

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Correct Answer is C

Explanation

Choice A reason: Surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place.

Choice B reason: Hypercapnia is the presence of higher-than-normal levels of carbon dioxide in the blood.

Choice C reason: Malignant hyperthermia is a life-threatening pharmacogenetic reaction to certain general anesthesia, characterized by hypermetabolism resulting in high body temperature, rigid muscles, and rapid heart rate.

Choice D reason: Hypertensive crisis is a severe elevation in blood pressure, often requiring immediate medical attention.

A. Vomiting B. Urticaria C. Low back pain D. Pulmonary congestion

Correct Answer is C

Explanation

Choice A reason: Vomiting can be a sign of a transfusion reaction, but it is not as specific as low back pain for an acute hemolytic reaction.

Choice B reason: Urticaria, or hives, may indicate an allergic reaction but is not specific to an acute hemolytic reaction.

Choice C reason: Low back pain is a classic symptom of an acute hemolytic reaction, which is a serious and potentially life-threatening condition that requires immediate attention.

Choice D reason: Pulmonary congestion may occur in various conditions and is not the most specific indicator of an acute hemolytic reaction.

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The nurse is caring for a patient undergoing surgery with the nursing diagnosis of deficient knowledge related to lack of previous surgical experience. Which nursing intervention is appropriate? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

During general surgery, a nurse observes tachycardia, muscle rigidity, respiratory acidosis, and hyperthermia in a patient. Which complication of surgery does the nurse suspect?

Correct Answer is C

Explanation

A nurse is assisting with the care of a client who is receiving a blood transfusion. The nurse should monitor for which of the following findings as an indication the client is having an acute hemolytic reaction?

Correct Answer is C

Explanation

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