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A client is scheduled for a routine physical assessment at the neighborhood clinic. What should the nurse do when physically assessing the client's oxygenation status? Select all that apply.

Observe for signs and symptoms of respiratory distress.

Auscultate anterior and posterior lung fields.

Inspect the skin for pallor and cyanosis.

Assess the shape, expansion, and symmetry of the chest.

Observe rate, rhythm, and depth of respirations.

Answer and Explanation

Correct Answer : A,B,C,E

A. Observe for signs and symptoms of respiratory distress.

B. Auscultate anterior and posterior lung fields.

C. Inspect the skin for pallor and cyanosis.

E. Observe rate, rhythm, and depth of respirations.

When assessing a client's oxygenation status, a nurse should observe for signs and symptoms of respiratory distress, such as dyspnea, wheezing, and use of accessory muscles. Auscultation of the anterior and posterior lung fields is important to identify any adventitious breath sounds such as crackles, wheezes or rhonchi that may indicate airway obstruction, fluid accumulation, or other respiratory abnormalities. Inspection of the skin is also important to detect pallor or cyanosis, which may indicate reduced oxygen levels in the blood. Lastly, observing the rate, rhythm, and depth of respirations can provide information on the adequacy of oxygen exchange in the lungs.

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Correct Answer is ["A","D","E"]

Explanation

correct answers are:

A. Avoid caffeine beverages at least 4 to 6 hours before bedtime.

D Maintain a regular sleep-wake cycle.

E Engage in a regular exercise routine at least 3 hours before going to bed.

The nurse would suggest the client avoid caffeine beverages because caffeine is a stimulant that can keep the client awake. The nurse would also recommend maintaining a regular sleep-wake cycle because the body responds to consistent sleep and wake times, which can help promote restful sleep. Engaging in a regular exercise routine at least 3 hours before going to bed can help promote sleep by reducing stress and anxiety, and improving physical health. However, the nurse would not recommend taking 2-hour naps during the day, as this can interfere with the ability to sleep at night, and obtaining a massage, although it may be relaxing, may not directly promote sleep.

A. Positive air pressure holds the mouth open. B. Negative pressure holds airways closed. C. Delivery of oxygen facilitates expiratory effort. D. Alternating waves of air stimulate breathing.

Correct Answer is D

Explanation

The correct answer is choice D, alternating waves of air stimulate breathing. CPAP works by delivering a continuous stream of pressurized air through a mask, which is worn over the nose or nose and mouth while sleeping. This air pressure acts like a splint, holding the airway open and preventing it from collapsing during sleep. The alternating waves of air delivered by the CPAP machine help stimulate breathing, keeping the airway open and reducing the number of breathing pauses that occur during sleep. CPAP is a highly effective treatment for obstructive sleep apnea, a condition in which the airway becomes blocked during sleep, leading to breathing pauses and interrupted sleep. By keeping the airway open and stimulating breathing, CPAP helps to improve sleep quality, reduce daytime sleepiness, and improve overall health outcomes in people with sleep apnea.

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A client is scheduled for a routine physical assessment at the neighborhood clinic. What should the nurse do when physically assessing the client's oxygenation status? Select all that apply.

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Naxlex Comprehensive Predictor Exams

A nurse is providing education to a client diagnosed with insomnia. What sleeppromoting techniques would the nurse suggest to help the client's condition? Select all that apply.

Correct Answer is ["A","D","E"]

Explanation

What is the rationale for using continuous positive air pressure (CPAP) to treat sleep apnea?

Correct Answer is D

Explanation

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