A nurse is caring for a client who will be placed on strict bed rest after surgery. The nurse should educate the client on the use of an incentive spirometer. The use of an incentive spirometer would prevent which postoperative complication?

Urinary tract infection

Deep vein thrombosis

Constipation

Atelectasis

Answer and Explanation

The Correct Answer is D

Choice A Reason:

Urinary tract infections (UTIs) are typically caused by bacteria entering the urinary tract. While strict bed rest can increase the risk of UTIs due to factors like catheter use and reduced mobility, the use of an incentive spirometer does not directly prevent UTIs. Instead, preventing UTIs involves maintaining good hygiene, ensuring adequate fluid intake, and, if necessary, using catheters properly.

Choice B Reason:

Deep vein thrombosis (DVT) is a condition where blood clots form in the deep veins, usually in the legs. This can occur due to prolonged immobility, such as strict bed rest after surgery. Preventing DVT involves measures like using compression stockings, administering anticoagulant medications, and encouraging leg exercises. An incentive spirometer, which is used to improve lung function, does not directly prevent DVT.

Choice C Reason:

Constipation is a common issue for patients on bed rest due to reduced physical activity and changes in diet. Preventing constipation involves ensuring adequate hydration, providing a high-fiber diet, and encouraging as much physical activity as possible. The use of an incentive spirometer, which focuses on respiratory function, does not directly address constipation.

Choice D Reason:

Atelectasis is a condition where the alveoli in the lungs collapse, leading to reduced or absent breath sounds in the affected areas. This is a common postoperative complication, especially in patients on strict bed rest, due to shallow breathing and reduced lung expansion. The use of an incentive spirometer encourages deep breathing and helps to keep the alveoli open, thereby preventing atelectasis. This is why the incentive spirometer is an essential tool for postoperative respiratory care.

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Correct Answer is A

Explanation

Choice A Reason:

Repeating auscultation after asking the client to take a deep breath and cough is the first intervention the nurse should take. This action helps to clear any secretions or mucus that might be causing the crackles. If the crackles persist after the client coughs, it indicates that the sounds are likely due to fluid in the lungs, which requires further assessment and intervention. This step ensures that the nurse accurately identifies the cause of the crackles before proceeding with other interventions.

Choice B Reason:

Instructing the client to limit fluid intake to less than 2,000 mL/day might be appropriate in cases of fluid overload or heart failure, but it is not the first intervention. The nurse needs to confirm the cause of the crackles before making any recommendations about fluid intake. Limiting fluid intake without proper assessment could lead to dehydration and other complications.

Choice C Reason:

Placing the client on bed rest in semi-Fowler’s position can help improve lung expansion and oxygenation by reducing pressure on the diaphragm. However, this is not the first intervention. The nurse should first determine if the crackles are due to secretions that can be cleared by coughing. Semi-Fowler’s position is beneficial for patients with respiratory distress, but it does not address the immediate need to reassess lung sounds.

Choice D Reason:

Preparing to administer antibiotics is not the first intervention. Antibiotics are used to treat infections, and the nurse needs to confirm whether the crackles are due to an infection or another cause before administering medication. Immediate administration of antibiotics without proper assessment could lead to inappropriate treatment and antibiotic resistance.

A. Do not take the medication before bedtime. B. Take the medication with a full glass of water. C. This medication must be taken on an empty stomach. D. Expect abdominal pain with this medication.

Correct Answer is B

Explanation

Choice A Reason:

“Do not take the medication before bedtime” is incorrect because the timing of medication administration depends on the specific medication and its intended effects. Some medications are specifically prescribed to be taken at bedtime to help with sleep or to reduce side effects that might occur during the day.

Choice B Reason:

“Take the medication with a full glass of water” is correct because many medications require adequate hydration to ensure proper absorption and to prevent irritation of the esophagus and stomach. Taking medication with a full glass of water helps to ensure that the medication reaches the stomach quickly and reduces the risk of esophageal irritation or damage.

Choice C Reason:

“This medication must be taken on an empty stomach” is incorrect unless the specific medication requires it. Some medications are better absorbed on an empty stomach, but this is not a universal rule and depends on the medication’s formulation and intended use.

Choice D Reason:

“Expect abdominal pain with this medication” is incorrect because not all medications cause abdominal pain. If a medication is known to cause abdominal pain, the nurse should provide additional instructions on how to manage this side effect or discuss alternative medications with the healthcare provider.

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A nurse is caring for a client who will be placed on strict bed rest after surgery. The nurse should educate the client on the use of an incentive spirometer. The use of an incentive spirometer would prevent which postoperative complication?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is auscultating a client’s lung sounds and identifies crackles in the left lower lobe. Which intervention should the nurse take first?

Correct Answer is A

Explanation

A nurse is teaching a client who is taking medication before bedtime. The nurse should include the following instructions:

Correct Answer is B

Explanation

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