A nurse is assisting in the care of a client who has pneumonia in the medical unit.

Exhibits

Which of the following information should the nurse include in discharge teaching for the client? (Select all that apply)

Take antibiotics for 10 days.

Ensure the oxygen delivery system is at least 8 feet from any heat source.

Decrease the steroid dose each day.

Take antibiotic medication with or without food.

Adjust the oxygen flow rate as needed to ease breathing.

Take steroid medication in the morning.

Answer and Explanation

Correct Answer : A,B

Choice A rationale: It is important for the client to complete the full course of antibiotics to ensure the infection is fully treated and to prevent antibiotic resistance.

Choice B rationale: Keeping the oxygen delivery system at least 8 feet from any heat source is crucial for safety to prevent the risk of fire.

Choice C rationale: Decreasing the steroid dose each day is not relevant in this case since there is no mention of the client being on steroids for the pneumonia treatment.

Choice D rationale: While taking antibiotic medication with or without food can be important, the specific instruction for this medication should be based on the pharmacist's or provider's recommendation. However, this option is not the best answer compared to completing the full course of antibiotics.

Choice E rationale: Adjusting the oxygen flow rate as needed to ease breathing should only be done under medical supervision. Clients are typically instructed to use a prescribed oxygen flow rate, and adjustments should not be made without consulting a healthcare provider.

Choice F rationale: Taking steroid medication in the morning can help reduce side effects, but again, this option is not relevant since the client's current treatment does not include steroids.

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Correct Answer is C

Explanation

Choice A rationale

Applying suction while inserting the catheter is incorrect and can cause tissue damage and hypoxia. Suction should only be applied while withdrawing the catheter to prevent injury to the tracheal mucosa.

Choice B rationale

Applying intermittent suction for up to 30 seconds is excessive and can cause hypoxia and trauma to the trachea. The correct duration for intermittent suctioning is 10-15 seconds per pass to minimize these risks.

Choice C rationale

Preoxygenating the client prior to suctioning helps prevent hypoxia by ensuring the client has adequate oxygen reserves during the procedure. This is a standard practice to enhance patient safety during suctioning.

Choice D rationale

Instructing the client to swallow during catheter insertion is inappropriate and can lead to gagging or aspiration. The client should be relaxed and still during insertion to prevent complications.

A. Place the specimen in a clean specimen cup. B. Remove 45 mL of urine from the catheter with a syringe. C. Clamp the catheter tubing below the needleless port. D. Clamp the catheter tubing for 60 min.

Correct Answer is C

Explanation

Choice A rationale

Placing the specimen in a clean specimen cup is not appropriate for a urine culture and sensitivity test. A sterile specimen cup is required to avoid contamination and ensure accurate results.

Choice B rationale

Removing 45 mL of urine from the catheter with a syringe is incorrect. Only 5-10 mL of urine is needed for a culture and sensitivity test, and excessive removal can lead to inaccurate test results or sample contamination.

Choice C rationale

Clamping the catheter tubing below the needleless port is the correct action. This allows urine to accumulate in the tubing, providing a fresh and uncontaminated sample for the culture and sensitivity test.

Choice D rationale

Clamping the catheter tubing for 60 minutes is too long and can cause urine stasis, increasing the risk of catheter-associated urinary tract infections. The tubing should be clamped only for a short duration to collect an adequate sample. .

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A nurse is assisting in the care of a client who has pneumonia in the medical unit. Exhibits Which of the following information should the nurse include in discharge teaching for the client? (Select all that apply)

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A nurse is assisting in the care of a client who has pneumonia in the medical unit.

Exhibits

Which of the following information should the nurse include in discharge teaching for the client? (Select all that apply)