A client with stage II ovarian cancer undergoes a total abdominal hysterectomy and bilateral salpingo- oopherectomy with tumor secretion, omentectomy, appendectomy, and lymphadenopathy. During the second postoperative day, which of the following assessment findings would raise concern in the nurse?

Correct Answer: D

Rationale: Shallow breathing and increasing lethargy are concerning assessment findings postoperatively as they can be indicative of respiratory complications such as atelectasis, pneumonia, or pulmonary embolism. These conditions can be life-threatening and require prompt medical attention. It is essential for the nurse to monitor the client closely for any signs of respiratory distress and intervene immediately if these symptoms are present. Abdominal pain, serous drainage from the incision, and hypoactive bowel sounds are common findings after abdominal surgery and are expected in the early postoperative period.

Correct Answer: D

Rationale: In the context of pediatric emergency nursing, understanding the major treatment modalities for breast cancer is crucial for providing comprehensive care to pediatric patients and their families. The correct answer, option D (All of these), encompasses the multidisciplinary approach often used in treating breast cancer. Surgery (option A) plays a significant role in the treatment of breast cancer by removing the primary tumor. It helps in reducing the tumor burden and can be curative, especially in early-stage disease. Radiotherapy (option B) is essential in destroying microscopic disease that may remain in the breast or nearby tissues after surgery. It helps in reducing the risk of local recurrence. Chemotherapy (option C) is a systemic treatment that targets cancer cells throughout the body. It is used to destroy cancer cells that may have spread beyond the breast and lymph nodes. The other options (A, B, and C) are not comprehensive on their own and do not cover all aspects of breast cancer treatment. Understanding the combination of surgery, radiotherapy, and chemotherapy as the main treatment modalities provides a more holistic and effective approach to managing breast cancer in pediatric patients. Educationally, it is essential to emphasize the importance of a multidisciplinary approach in treating breast cancer to ensure the best outcomes for patients. By understanding the rationale behind each treatment modality and how they work together, pediatric emergency nurses can better support patients and families facing a breast cancer diagnosis.

Correct Answer: D

Rationale: Understanding discharge instructions is one of the key criteria for discharging patients following surgery in an ambulatory setting. It ensures that the patient comprehends how to care for themselves post-surgery and reduces the risk of complications or the need for readmission. While the other options may also be important factors, having a clear understanding of discharge instructions is crucial for the patient's recovery and overall well-being.

Correct Answer: B

Rationale: Morphine is given in acute pulmonary edema to decrease pulmonary capillary pressure. By reducing pulmonary capillary pressure, morphine helps to redistribute the pulmonary circulation to the periphery, leading to improved oxygenation and decreased symptoms of pulmonary edema. Morphine works to vasodilate the blood vessels, which ultimately helps decrease the pressure in the pulmonary capillaries, allowing for improved blood flow to the periphery of the lungs. This redistribution of pulmonary circulation helps to alleviate the congestion and fluid buildup in the lungs that occurs in acute pulmonary edema.

Correct Answer: A

Rationale: Right-sided heart failure is characterized by the inability of the right side of the heart to pump blood effectively, leading to fluid accumulation in the systemic venous system. This fluid overload typically manifests as signs of congestion in the peripheral tissues. Dependent pitting edema is a classic symptom of right-sided heart failure, where swelling is noted in the lower extremities and sacral area, worsening later in the day due to the effects of gravity. Orthopnea (B) and exertional dyspnea (C) are more indicative of left-sided heart failure, where congestion occurs in the pulmonary system. Hemoptysis (D) refers to coughing up blood and is not a classic symptom of heart failure but may be seen in conditions such as pulmonary embolism or infection.