Which of the following assessments of a client transferred to the post-anesthesia care unit (PACU) from the operating room would NOT necessarily indicate a postoperative complication to the nurse?
a. acute inspiratory stridor with sternal retractions
b. labored chest movement
c. snoring
d. peripheral cyanosis
D
Postanesthesia nurses are responsible for managing seven areas of risk: ineffective airway clearance, ineffective breathing patterns, aspiration, decreased cardiac output, fluid volume deficit, sensory or perceptual alterations, injury, and altered thought processes. Peripheral cyanosis may be a sign of hypothermia rather than respiratory distress.
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When the breastfeeding mother asks about nutritional needs while breastfeeding, the nurse gives her a brochure showing the recommended nutritional requirements during breastfeeding as:
a. an additional 1000 mL of fluids. b. prenatal vitamins and an additional 300 calories. c. at least three glasses of milk a day. d. a well-balanced diet with 500 additional calories.
When palpating the child's cervical lymph nodes, the nurse notes that they are tender, enlarged, and warm. What is the best explanation for this?
a. Some form of cancer b. Local scalp infection common in children c. Infection or inflammation distal to the site d. Infection or inflammation close to the site
A client scheduled for surgery has arranged for an autologous transfusion. What type of blood transfusion is this?
A) The client's family members have been donors. B) The client donates his or her own blood. C) The client's blood has been rendered sterile. D) The client will only need fluids, not blood.
When teaching the patient and family about CISC, why is it important for the nurse to teach about the signs and symptoms of complications?
a. Although rare, complications are always severe. b. It is part of the process; complications almost never occur. c. Urinary complications are common with CISC. d. The only major complication is infection.