A nurse is contributing to the plan of care for a client who has a chest tube set to continuous suction to relieve a pneumothorax. Which of the following interventions should the nurse include?

Ensure the device is kept below the level of the client's chest.

Clamp the chest tube every 4 hr.

Place the client in a supine position.

Empty the collection chamber every 8 hr.

Answer and Explanation

The Correct Answer is A

Ensuring the device is kept below the level of the client's chest is important to ensure that the drainage system functions properly by allowing the fluid and air to flow downhill. Placing the device below the level of the chest helps facilitate gravity drainage.

Continuous suction is required for proper functioning of the chest tube drainage system. Clamping the chest tube can disrupt the suction and impede the removal of air or fluid from the pleural space. Only in specific circumstances, such as when changing the drainage system or assessing for air leaks, may the healthcare provider request a temporary clamping of the chest tube.

Positioning the client semi-Fowler's, with the head of the bed elevated, can help promote lung expansion and improve oxygenation. The specific positioning may vary depending on the client's condition and the healthcare provider's recommendations.

The nurse should empty the collection chamber as per the facility's protocol, which typically includes monitoring the drainage and emptying it when it reaches a certain level. Regular emptying of the collection chamber helps maintain proper functioning of the chest tube system and allows for accurate measurement of drainage output.

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Correct Answer is D

Explanation

The APN, also known as a nurse practitioner or clinical nurse specialist, has advanced knowledge and expertise in pharmacology and medication management. They are trained to assess medication interactions, evaluate potential risks, and provide guidance to ensure safe and effective medication use.

The other members of the interdisciplinary team listed are not specifically trained to address medication interactions:

Social worker: Social workers focus on addressing psychosocial aspects of care, such as emotional support, counseling, and resource coordination. While they may provide valuable assistance in various areas of the client's care, they typically do not have specialized knowledge in medication interactions.
Patient care technician: Patient care technicians, also known as nursing assistants or certified nursing assistants, provide direct patient care under the supervision of nurses. They do not typically have the training or authority to address medication interactions.
Psychologist: Psychologists specialize in the assessment, diagnosis, and treatment of mental and emotional health concerns. While they may be involved in the client's overall care, including medication management for mental health conditions, their expertise lies primarily in psychological assessment and therapy rather than medication interactions.

A. Assign the client to a negative pressure airflow room B. Have visitors remain at least 0.91 m (3 feet) away from the client C. Initiate contact precautions for the client D. Administer aspirin if the client develops a fever

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

Explanation

Varicella zoster is highly contagious, and airborne precautions should be implemented. Assigning the client to a negative pressure airflow room helps prevent the spread of the virus to others by containing and filtering the air within the room.

In addition to airborne precautions, contact precautions should also be implemented. This includes using gloves and gowns when providing care to the client to minimize direct contact with infectious materials.

The other options listed are not appropriate interventions for a client with varicella zoster: While it is important to minimize close contact with an infectious client, varicella zoster is primarily transmitted through airborne droplets. Visitors should follow the appropriate precautions, such as wearing masks and adhering to hand hygiene, rather than just maintaining a certain distance.

Aspirin should not be given to clients with varicella zoster, especially children, due to the risk of developing Reye's syndrome. Reye's syndrome is a rare but serious condition that can cause swelling in the liver and brain. Acetaminophen (paracetamol) is typically recommended for managing fever in clients with varicella zoster.

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A nurse is contributing to the plan of care for a client who has a chest tube set to continuous suction to relieve a pneumothorax. Which of the following interventions should the nurse include?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is taking multiple medications and asks about possible interactions. To which of the following members of the interdisciplinary team should the nurse make a referral?

Correct Answer is D

Explanation

A nurse is assisting with the admission of a client who has varicella zoster. Which of the following interventions should the nurse plan to implement?

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

Explanation

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