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The nurse is giving discharge instructions to a client newly diagnosed with lung cancer. The nurse understands the client requires additional discharge teaching when the client states:

A.

"I will really try to quit smoking so I will use the Nicorette gum to help."

B.

"We will contact the American Cancer Society to help my family and I cope with all of this."

C.

"It's ok for other people to smoke in the house around me, so long as I don't smoke myself."

D.

"My family and I will spend more time together doing things we like to do."

Answer and Explanation

The Correct Answer is C

A. This statement indicates the client is aware of the importance of quitting smoking and is taking steps to do so, which is a positive action in managing their health after a lung cancer diagnosis.  

 

B. Contacting the American Cancer Society shows the client and their family are seeking support, which is beneficial for coping with cancer, indicating good understanding of available resources. 

 

C. Allowing others to smoke in the house poses significant health risks due to secondhand smoke exposure, which can aggravate the client's condition and hinder recovery. This indicates a lack of understanding regarding the dangers of smoking and the need for a smoke-free environment.  

 

D. Spending quality time with family is a positive coping mechanism and reflects the client’s recognition of the importance of emotional support during their treatment journey.


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Correct Answer is C

Explanation

A. Assessing pupils is important, but it provides only partial information about the overall neurologic status and does not give a comprehensive picture of improvement or deterioration.

B. Vital signs can indicate some changes in condition but are not specific to neurologic status and do not provide detailed insight into cognitive or motor function.

C. Performing serial Glasgow Coma Scales allows for a standardized and objective assessment of a patient's level of consciousness, motor responses, and verbal responses over time, making it the most effective method to evaluate neurologic status.

D. The Mini Mental Status Exam provides useful information about cognitive function but may not capture acute changes in neurologic status as effectively as the Glasgow Coma Scale.

Correct Answer is C

Explanation

A. The absence of bowel sounds shortly after surgery is a common finding and does not necessarily indicate a complication at this time; it is expected during the initial postoperative period.

B. An SPO2 of 90% while the client is asleep is concerning, but it does not take precedence over signs of possible surgical complications that could require immediate intervention.

C. Increasing abdominal distention is a critical sign that could indicate serious complications such as an anastomotic leak, bowel obstruction, or intra-abdominal bleeding, and it requires immediate notification of the surgeon for further evaluation and potential intervention.

D. A small amount of green-tinged fluid from the nasogastric tube is typical postoperatively and does not necessitate immediate notification to the surgeon unless the volume is excessive or other concerning signs are present.

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