A client with obstructive sleep apnea is preparing for sleep. Which action should the practical nurse (PN) implement?

Assist in turning the client to one side.

Keep oral suction equipment nearby.

Offer to bring the client a sleeping pill.

Place a cool air humidifier in the room.

Answer and Explanation

The Correct Answer is A

The correct answer is Choice A:

Assist in turning the client to one side. Choice A rationale:

When preparing a client with obstructive sleep apnea for sleep, the practical nurse (PN) should assist the client in turning to one side. This position is known as the lateral position and can be beneficial for clients with obstructive sleep apnea. Lying on one's side can help to reduce the likelihood of airway obstruction and minimize the occurrence of apnea (pauses in breathing) during sleep. This position promotes better airflow and can improve the client's overall sleep quality.

Choice B rationale:

Keeping oral suction equipment nearby (Choice B) might be appropriate for clients with respiratory issues or a risk of airway obstruction. However, it is not the best action for a client with obstructive sleep apnea. Sleep apnea primarily involves upper airway collapse, not excessive secretions or obstructions in the oral cavity.

Choice C rationale:

Offering to bring the client a sleeping pill (Choice C) is not an appropriate action for a client with obstructive sleep apnea. Sleep apnea is characterized by repeated episodes of blocked or restricted airflow during sleep. Sedative medications can further relax the muscles in the airway, worsening the condition and potentially leading to more severe apnea.

Choice D rationale:

Placing a cool air humidifier in the room (Choice D) may be helpful for clients who experience dryness or congestion in the airways during sleep. However, it is not specifically indicated for obstructive sleep apnea. While humidifiers can be beneficial for some sleep-related issues, they do not address the underlying cause of sleep apnea.

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Correct Answer is B

Explanation

Choice A rationale:

The risk of infection is not the priority nursing problem in this scenario. While the darkened membranes and smoky breath may be indicative of potential infection, addressing ineffective airway clearance is more urgent as it directly impacts the client's breathing and oxygenation.

Choice B rationale:

Ineffective airway clearance should be the priority nursing problem. Darkened membranes of the mouth and smoky breath suggest possible inhalation injury or airway obstruction.

Maintaining a patent airway is crucial for adequate oxygenation and to prevent further complications.

Choice C rationale:

Acute pain is not the priority nursing problem in this case. Although it is essential to address any discomfort the client may be experiencing, it takes a back seat to the more critical issue of ineffective airway clearance.

Choice D rationale:

Disturbed body image is not the priority nursing problem when the client has darkened mouth membranes and smoky breath. While it is important to address body image concerns, the immediate focus should be on managing and improving the client's airway clearance.

A. Clear lung sounds, CPM (continuous passive motion) on. B. B. Call bell, side rails, bed in low position, and ambulation aids. C. Paresthesia, paralysis, pedal pulses, pallor, and pain. D. Blood pressure 138/88, pain scale 7, and respirations 22.

Correct Answer is C

Explanation

The correct answer is choice C - Paresthesia, paralysis, pedal pulses, pallor, and pain.

Choice A rationale:

Clear lung sounds, CPM (continuous passive motion) on. While assessing lung sounds and the

use of CPM after knee replacement is essential, it may not be the most critical information to document in the client's electronic medical record (EMR) compared to other potential complications.

Choice B rationale:

Call bell, side rails, bed in low position, and ambulation aids. These are important safety measures and assistive devices for the client's post-operative recovery. While documenting these measures is important, they are not the most crucial findings to be documented in the EMR.

Choice C rationale:

Paresthesia, paralysis, pedal pulses, pallor, and pain. After a total knee replacement, it is crucial to assess the neurovascular status of the affected leg to identify any potential complications like nerve damage, circulatory impairment, or blood clot formation.

Documenting these assessments in the EMR helps monitor the client's progress and identify any changes that may require immediate intervention.

Choice D rationale:

Blood pressure 138/88, pain scale 7, and respirations 22. While monitoring vital signs and pain levels is important, these parameters are not the top priority in this situation.

Neurovascular assessments are more critical for the early detection of complications.

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A client with obstructive sleep apnea is preparing for sleep. Which action should the practical nurse (PN) implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The practical nurse (PN) is caring for a client who has darkened membranes of the mouth and a smoky breath. Which priority nursing problem should the PN include in the plan of care?

Correct Answer is B

Explanation

An older male client is returning to the surgical unit after a total right knee replacement. Which assessment findings are most important for the practical nurse (PN) to document in this client's electronic medical record (EMR)?

Correct Answer is C

Explanation

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