To ensure client adherence to the postoperative regimen, which content is most important for the nurse to include in the preoperative teaching?
"You will feel drowsy for several hours after surgery."
"You will need to get out of bed the day after surgery."
"Your clear liquid diet will include gelatine and tea."
"Your bowel sounds will be assessed every four hours."
The Correct Answer is B
Choice A reason: Informing the client that they will feel drowsy for several hours after surgery is important for setting realistic expectations about the immediate postoperative period. However, it is not the most critical information to ensure adherence to the postoperative regimen.
Choice B reason: It is essential to inform the client about the importance of early mobilization, which involves getting out of bed the day after surgery. Early mobilization helps prevent complications such as deep vein thrombosis (DVT), pulmonary embolism, and pneumonia. Emphasizing this information preoperatively ensures that the client understands the necessity of moving and participating in their recovery process, which is vital for successful postoperative outcomes.
Choice C reason: Explaining the components of a clear liquid diet, including gelatine and tea, is helpful for the client to know what to expect in terms of dietary modifications. However, it is not as critical as informing the client about early mobilization, which has a direct impact on their recovery and prevention of complications.
Choice D reason: Informing the client that their bowel sounds will be assessed every four hours is part of routine postoperative care. While it is important for the client to understand the monitoring process, it is not the most crucial aspect to ensure adherence to the postoperative regimen. Early mobilization has a more significant impact on the client’s overall recovery.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Lethargy and lack of appetite are symptoms that might indicate hypothyroidism or an insufficient dosage of levothyroxine. These symptoms are not typically associated with a dosage that is too high.
Choice B reason: Bradycardia and constipation are also indicative of hypothyroidism or an inadequate dosage of levothyroxine. These symptoms suggest a need for a higher dosage rather than indicating that the current dosage is too high.
Choice C reason: Muscle cramping and dry, flushed skin can be associated with electrolyte imbalances or dehydration, but they are not specific symptoms of an excessive dosage of levothyroxine.
Choice D reason: Palpitations and shortness of breath are signs of hyperthyroidism, which can occur if the dosage of levothyroxine is too high. These symptoms indicate that the client's metabolism is excessively stimulated, leading to cardiovascular strain and respiratory distress. It is crucial for the nurse to monitor these symptoms and adjust the medication dosage accordingly.
Correct Answer is B
Explanation
Choice A reason: Placing the client in a darkened room may help alleviate symptoms if the headache is related to migraine or sensitivity to light, but it does not address the potential underlying cause of the severe headache and blurred vision in a client with a history of diabetes and hypertension.
Choice B reason: Obtaining a blood pressure reading is the most critical first step. Severe headache and blurred vision can be symptoms of hypertensive crisis, which is a medical emergency that requires immediate attention to prevent complications such as stroke or organ damage. Checking the blood pressure will help determine if the client's symptoms are due to elevated blood pressure.
Choice C reason: Administering an oral analgesic may provide temporary relief for the headache, but it does not address the potential underlying causes of the symptoms. The priority is to assess and manage any potentially life-threatening conditions.
Choice D reason: Performing a finger stick glucose test is important for monitoring blood glucose levels in a client with diabetes. However, in the context of the severe headache and blurred vision, the immediate concern should be to rule out hypertensive crisis by checking the blood pressure first. Blood glucose can be checked after ensuring the client's blood pressure is not critically high.
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