What is the nurse's highest priority when planning preoperative teaching for a client who is scheduled for an appendectomy?
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A. The client should begin coughing and deep-breathing exercises as soon as he s able to follow instructions. B. Surgical wound infection is most likely to occur during the first postoperative day. C. The client should be encouraged to take food and fluids to prevent dehydration and malnutrition. D. The client s skin should be assessed hourly.
The correct answer is option A
The nurse’s highest priority when planning preoperative teaching for a client who is scheduled for an appendectomy is to tell the client to begin coughing and deep breathing exercises as soon as he can follow instruction after surgery, this will help prevent lung collapse and possible lung infection.
Wound infection is of great concern postoperatively but it is less likely to occur during the first postoperative day.
The client shouldn’t be encouraged to take fluids or foods until bowel sounds are observed postoperatively.
The skin should be assessed when the client changes position or get out of bed. There is concern and need to assess the skin every hour.
The client should begin coughing and deep-breathing exercises as soon as he\ s able to follow instructions.-rationale: the nurse should encourage the client to cough and breathe deeply as soon as possible after surgery to help prevent atelectasis and pneumonia. she shouldnt encourage the client to take food or fluids until bowel sounds are present (usually 24 hours postoperatively). wound infection is a concern, but usually not during the first postoperative day. the nurse should assess the clients skin every 2 hours when he is made to either change position or get out of bed.client needs category: physiological integrityclient needs subcategory: reduction of risk potentialcognitive level: applicationreference: taylor, c., et al. fundamentals of nursing: the art and science of nursing care, 6th ed. philadelphia: lippincott williams & wilkins, 2008, p. 888.