A nurse is caring for a patient who has respiratory alkalosis and hyperventilating. Which of the following interventions should the nurse implement?

Administer sodium bicarbonate to the patient.

Provide a paper bag for the patient to breathe into.

Monitor the patient's head being between their knees.

Administer acetazolamide to the patient.

Answer and Explanation

The Correct Answer is B

Choice A reason: Administering sodium bicarbonate is not indicated for respiratory alkalosis as it is an alkalinizing agent and could worsen the condition.

Choice B reason: Breathing into a paper bag can help to rebreathe CO2, which can help correct the pH in cases of hyperventilation-induced respiratory alkalosis.

Choice C reason: Having the patient's head between their knees is not a standard intervention for respiratory alkalosis and could be uncomfortable or unsafe for the patient.

Choice D reason: Acetazolamide is a diuretic that can cause metabolic acidosis to compensate for respiratory alkalosis, but it is not typically used for acute management of hyperventilation.

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

Explanation

Choice A reason: Performing deep breathing exercises every 2 hours helps prevent postoperative complications such as pneumonia and atelectasis.

Choice B reason: While chest movement is part of breathing, the instruction is incomplete and should emphasize diaphragmatic breathing rather than shoulder movement.

Choice C reason: Taking a deep breath before coughing helps to increase the eﬀectiveness of the cough, which can clear secretions from the lungs.

Choice D reason: Sitting up straight before beginning coughing exercises helps to ensure maximum lung expansion and eﬀectiveness of the cough.

Choice E reason: Using a pillow to support the surgical area when coughing can help reduce pain and protect the incision site, making the cough more eﬀective.

A. Verify that the patient is giving consent voluntarily. B. Explain the amount of pain the patient will have following the procedure. C. Tell the patient the names of other health care providers who will participate in the surgery. D. Inform the patient of the possible outcomes if they do not receive the treatment.

Correct Answer is A

Explanation

Choice A reason: It is essential to ensure that the patient's consent is given freely without coercion. This is a fundamental ethical principle in healthcare.

Choice B reason: While it is important to discuss postoperative expectations with the patient, explaining the amount of pain is not part of the informed consent process but rather part of preoperative education.

Choice C reason: Providing the names of the healthcare team members is not a required element of informed consent, although it may be part of the broader communication with the patient.

Choice D reason: Discussing the consequences of not undergoing the procedure can be part of the informed consent process, but the primary action is to confirm voluntary consent.

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A nurse is caring for a patient who has respiratory alkalosis and hyperventilating. Which of the following interventions should the nurse implement?

Nursing Test Bank

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