A nurse is caring for a client who has pneumonia. Which of the following actions should the nurse take to promote thinning of respiratory secretions?

Encourage coughing and deep breathing

Encourage regular use of the incentive spirometer

Encourage the client to increase ﬂuid intake

Encourage the client to ambulate frequently

Answer and Explanation

The Correct Answer is C

Increasing ﬂuid intake helps to hydrate the mucous membranes and thin the respiratory secretions, which facilitates expectoration and improves gas exchange.

Encourage coughing and deep breathing. This is beneficial for clearing the airways and preventing atelectasis, but it does not directly aﬀect the viscosity of the secretions.
Encourage regular use of the incentive spirometer. This is helpful for expanding the lungs and preventing complications such as pneumonia or pleural eﬀusion, but it does not inﬂuence the consistency of the secretions.
Encourage the client to ambulate frequently. This is important for promoting circulation and mobility, but it does not have a significant eﬀect on the thinning of the secretions.

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Correct Answer is A

Explanation

Performing the procedure independently is the best indicator of the partner's readiness for the client's discharge, as it demonstrates competence and confidence in suctioning. Suctioning is a skill that requires practice and supervision until mastery is achieved. The nurse should observe and evaluate the partner's performance of suctioning and provide feedback and reinforcement as needed.

b) Attending a class given about tracheostomy care is a good action by the partner, but not the best indicator of readiness for the client's discharge. Attending a class can provide information and education about tracheostomy care, but it does not necessarily translate into skill acquisition or application. The nurse should assess the partner's understanding and retention of the information and provide additional teaching or clarification as needed.
c) Verbalizing all steps in the procedure is a good action by the partner, but not the best indicator of readiness for the client's discharge. Verbalizing all steps in the procedure can help the partner remember and follow the correct sequence and technique of suctioning, but it does not necessarily reﬂect actual performance or ability. The nurse should observe and verify that the partner is doing what they are saying and correct any errors or omissions as needed.
d) Asking appropriate questions about suctioning is a good action by the partner, but not the best indicator of readiness for the client's discharge. Asking appropriate questions about suctioning can show interest and involvement in learning and caring for the client, but it does not necessarily indicate competence or confidence in suctioning. The nurse should answer the partner's questions and provide additional resources or referrals as needed.

A. Post no smoking signs in a prominent location in the home. B. Verify the oxygen ﬂow rate every other day. C. Check the tops of the ears for skin breakdown. D. Apply petroleum ointment to nares if they become dry and irritated. E. Check the cannula position on a regular basis.

Correct Answer is ["A","C","E"]

Explanation

These are important safety and comfort measures for a client who uses home oxygen therapy via a nasal cannula.

The other options are not correct because:

b. Verify the oxygen ﬂow rate every other day. This is not frequent enough, as the ﬂow rate should be checked at least daily and whenever the client feels short of breath or has changes in vital signs.

d. Apply petroleum ointment to nares if they become dry and irritated. This is not recommended, as petroleum products can ignite in the presence of oxygen and cause burns or fire. A water-based lubricant should be used instead.

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A nurse is caring for a client who has pneumonia. Which of the following actions should the nurse take to promote thinning of respiratory secretions?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client with a tracheostomy. The client's partner has been taught to perform suctioning. Which of the following actions by the partner should indicate to the nurse a readiness for the client's discharge?

Correct Answer is A

Explanation

A nurse is providing discharge teaching to a client who has a new prescription for home oxygen therapy via a nasal cannula. Which of the following should the nurse include in the teaching? (Select all that apply)

Correct Answer is ["A","C","E"]

Explanation

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