A nurse is caring for a child who has cystic fibrosis and receives chest physiotherapy (CPT). Which of the following actions should the nurse plan to take?
Perform vibration during the client's inspirations.
Percuss each lung segment for 15 min.
Administer albuterol prior to CPT.
Perform CPT immediately after the child eats.
The Correct Answer is C
A. Vibration is typically performed during exhalation, not inspiration. This helps to loosen secretions.
B. Percussion should not last 15 minutes per lung segment; it is generally performed for shorter periods to avoid discomfort or injury.
C. Administering albuterol prior to CPT helps open the airways, making it easier for the child to expectorate secretions. This is a standard practice for improving the effectiveness of CPT.
D. It is not recommended to perform CPT immediately after a meal, as it may increase the risk of aspiration or discomfort. It is usually advised to wait at least 30 minutes after eating.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. The first few days after surgery can involve some bleeding as part of normal healing, but the greatest risk for hemorrhage occurs later.
B. The greatest risk for post-operative hemorrhage after a tonsillectomy is typically 7 to 10 days post- surgery when the scabs formed in the throat start to fall off.
C. The 4 to 6-day window does not correlate with the peak risk for hemorrhage, which is typically observed later in the healing process.
D. The 11 to 14-day period is past the time when hemorrhage is most likely to occur.
Correct Answer is C
Explanation
A. Tracheoesophageal fistula is a congenital anomaly that affects the esophagus and is not associated with abdominal masses or blood and mucus in the stool.
B. Hypertrophic pyloric stenosis typically causes projectile vomiting and failure to thrive, but it does not typically present with an abdominal mass or blood in the stool.
C. Intussusception occurs when part of the intestine telescopes into another part, causing a mass, abdominal pain, and sometimes blood and mucus in the stools, which is consistent with the signs described.
D. Inguinal hernia is a protrusion of abdominal contents into the groin area, not typically associated with abdominal masses in the upper quadrant or blood in the stool.
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