A nurse is caring for a client at risk for atelectasis. Which independent nursing measure should the nurse prioritize to prevent atelectasis development?
Incentive spirometry
Increase oral fluid intake
Ambulation
Oxygen therapy
The Correct Answer is A
A. Incentive spirometry: This is the most effective independent nursing measure to prevent atelectasis. Incentive spirometry encourages deep breathing and lung expansion, which helps to keep the alveoli open and reduces the risk of collapse. It is particularly beneficial for clients at risk for atelectasis, such as those who have had surgery, are immobile, or have respiratory issues. Regular use of the incentive spirometer promotes optimal lung function and helps prevent the development of atelectasis.
B. Increase oral fluid intake: While maintaining adequate hydration is important for overall health and can help thin secretions, it is not as directly effective in preventing atelectasis as incentive spirometry. Increased fluid intake alone does not promote deep breathing or lung expansion, which are critical in preventing airway collapse.
C. Ambulation: Although ambulation is an important intervention for promoting overall mobility and respiratory function, it may not be as practical for all clients, especially those who are unable to move independently. While getting the client up and moving can help prevent atelectasis, the most immediate and effective measure remains the use of incentive spirometry, which can be performed regardless of the client’s mobility status.
D. Oxygen therapy: While oxygen therapy can help improve oxygenation in clients with respiratory issues, it does not directly prevent atelectasis. Providing supplemental oxygen does not address the need for lung expansion and deep breathing, which are essential in maintaining alveolar patency. Therefore, oxygen therapy should not be prioritized as the primary independent measure to prevent atelectasis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Supportive feedback: This term refers to positive, constructive input that aims to help a colleague improve their practice or decision-making. Nurse Taylor's behavior does not reflect supportive feedback; rather, it is negative and undermining, contributing to a hostile work environment.
B. Lateral violence: This term describes aggressive or bullying behavior exhibited by colleagues at the same hierarchical level. Nurse Taylor's sarcastic remarks and belittling comments toward Nurse Jordan are clear examples of lateral violence, as they create a toxic atmosphere and negatively impact team dynamics. This behavior can lead to increased stress and decreased morale among team members.
C. Workplace violence: While Nurse Taylor's behavior can be considered a form of workplace violence in a broader sense, it is more specifically classified as lateral violence. Workplace violence generally encompasses physical threats or harm, while lateral violence focuses on verbal and emotional abuse among coworkers.
D. Constructive criticism: Constructive criticism involves providing feedback aimed at improving performance while maintaining respect and professionalism. Nurse Taylor's sarcastic remarks do not meet this definition, as they are not aimed at helping Nurse Jordan but rather serve to belittle and undermine her. Therefore, this behavior is not constructive and instead falls into the category of lateral violence.
Correct Answer is ["15"]
Explanation
Formula:
Volume to administer (mL) = (Desired dose (mEq) / Available concentration (mEq/mL))
Desired dose = (40 mEq / 2 doses)
=20mEq
Available concentration = 6.7 mEq / 5 mL
Calculate the concentration per mL:
6.7 mEq / 5 mL = 1.34 mEq/mL
Volume to administer = 20 mEq / 1.34 mEq/mL
= 14.925... mL
Round to the nearest whole number:
Volume to administer = 15 mL
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