A nurse in a long-term care facility is assisting a client with eating during meal time and recognizes another client indicating he is choking. Which of the following situations requires the nurse to perform the Heimlich maneuver?

The client is coughing only.

The client is not making any sounds.

The client is able to whisper.

The client has a high-pitched inspiratory stridor.

Answer and Explanation

The Correct Answer is B

A. A client who is coughing only is still able to clear the airway by themselves.
B. Inability to make any sounds indicates a complete airway obstruction, requiring the Heimlich maneuver.
C. A client who can whisper has a partial airway obstruction and should be encouraged to continue coughing.
D. A high-pitched inspiratory stridor indicates a partial obstruction, not requiring the Heimlich maneuver but close monitoring.

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Correct Answer is ["B","C","D"]

Explanation

A. Traction weights are typically set by the physician and shouldn't be adjusted by the nurse unless specifically ordered.
B. Monitoring peripheral pulses helps assess circulation and neurovascular status in the affected extremity.
C. Examining the skin under the traction splint is essential to assess for skin integrity and prevent complications like pressure ulcers.
D. Assessing the temperature of the affected extremity helps detect signs of circulatory impairment or infection.
E. Positioning weights against the foot of the bed is not a correct action for managing Buck's traction.

A. Check the patency of the client's airway. B. Determine the poison that was ingested. C. Position the client side-lying D. Identify the amount of poison that was ingested.

Correct Answer is A

Explanation

A. Checking the patency of the client's airway is the priority action because maintaining a clear airway is crucial during a seizure to ensure adequate oxygenation and prevent aspiration.
B. Determining the poison is important but not the immediate priority during a seizure.
C. Positioning the client side-lying is important to prevent aspiration, but the first action should be to ensure the airway is clear.
D. Identifying the amount of poison ingested is important for treatment but not the immediate priority during a seizure.

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A nurse in a long-term care facility is assisting a client with eating during meal time and recognizes another client indicating he is choking. Which of the following situations requires the nurse to perform the Heimlich maneuver?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is in Buck's traction. Which of the following actions should the nurse take? (Select all that apply.)

Correct Answer is ["B","C","D"]

Explanation

A nurse is caring for a client who ingested a poison and is now experiencing a seizure. Which of the following is the priority action the nurse should take?

Correct Answer is A

Explanation

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