A critical-care nurse is caring for a client diagnosed with pneumonia as a surgical complication. The nurse’s assessment reveals that the client has an increased work of breathing due to copious tracheobronchial secretions. What should the nurse encourage the patient to do?
Lie in a low Fowler’s or supine position
Increase oral fluids unless contraindicated
Increase activity
Call the nurse for oral suctioning as needed
The Correct Answer is D
A. Lie in a low Fowler’s or supine position:
Lying in a low Fowler's or supine position may worsen respiratory distress and compromise oxygenation. It can reduce lung expansion and increase the work of breathing, especially in patients with pneumonia. This is not a recommended position for individuals with respiratory issues.
B. Increase oral fluids unless contraindicated:
Increasing oral fluids is generally a good practice, especially in respiratory conditions like pneumonia. It helps thin respiratory secretions, making them easier to clear. However, this alone may not address copious tracheobronchial secretions. Suctioning may be needed to effectively remove excess secretions.
C. Increase activity:
Increasing activity may be beneficial for some patients, but it might exacerbate respiratory distress in others, especially if they are already experiencing increased work of breathing. The appropriateness of increasing activity depends on the specific condition and the patient's overall stability.
D. Call the nurse for oral suctioning as needed:
This is the most appropriate choice. If the client is experiencing increased work of breathing due to copious tracheobronchial secretions, calling the nurse for oral suctioning is an intervention aimed at maintaining a clear airway and alleviating respiratory distress. Regular suctioning may be necessary to assist the client in managing secretions effectively.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. To ensure long-term prevention of asthma exacerbations:
This statement is not accurate. Prednisone is typically not used for long-term prevention of asthma exacerbations. It is more commonly prescribed for short-term use during acute exacerbations to quickly reduce inflammation and improve symptoms.
B. To gain control of inadequately controlled, persistent asthma:
This is the most accurate explanation. Prednisone is often prescribed to gain control over inadequately controlled, persistent asthma by providing anti-inflammatory effects and helping to manage symptoms during acute episodes.
C. To cure any systemic infection underlying asthma attacks:
Prednisone is not used to cure infections. While it can have anti-inflammatory and immunosuppressive effects, its primary role in asthma is to reduce airway inflammation and control symptoms, not to treat underlying infections.
D. To prevent recurrent pulmonary infections:
Prednisone is not typically prescribed for the prevention of infections. Its use in asthma is more focused on managing inflammation and symptoms during acute exacerbations rather than preventing infections.
Correct Answer is ["C","D","E"]
Explanation
A. Limit physical activity
Limiting physical activity is not a primary goal in heart failure care. In fact, promoting appropriate and monitored physical activity is often part of the overall management plan. Exercise, when tailored to the client's condition, can improve functional status and quality of life.
B. Prevent endocarditis
While preventing endocarditis is important for individuals with certain cardiac conditions, it is not a primary goal in the care of heart failure. The focus is typically on optimizing cardiac function and managing heart failure symptoms.
C. Relieve the patient’s symptoms
Managing and relieving symptoms, such as dyspnea, fatigue, and fluid retention, are crucial goals in heart failure care. This includes optimizing medication management and other therapeutic interventions.
D. Extend survival
While heart failure is a chronic condition, the goal is to optimize treatment to improve the client's prognosis and overall survival. This involves the use of evidence-based therapies to address the underlying causes and contributing factors.
E. Improve functional status
Enhancing the client's ability to perform activities of daily living and improving functional capacity are important goals. This can involve a combination of medications, lifestyle modifications, and rehabilitation.
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