A nurse is providing end-of-life care to a client who is experiencing dyspnea. Which of the following actions should the nurse take?
Provide oral care to the client once every 8 hr.
Reposition the client once every 4 hr.
Place the head of the client's bed flat.
Use a fan to circulate air in the client's room.
The Correct Answer is B
Rationale for A: Providing oral care once every 8 hours is not directly related to relieving dyspnea. Oral care addresses comfort related to dry mouth, but it doesn't improve breathing difficulties.
Rationale for B: Repositioning the client every 4 hours can help alleviate dyspnea by improving lung expansion and preventing pooling of secretions. It also helps in reducing pressure injuries, promoting comfort, and preventing complications.
Rationale for C: Placing the head of the bed flat can exacerbate dyspnea by hindering lung expansion. It is recommended to elevate the head of the bed to improve air exchange and breathing.
Rationale for D: While using a fan can help with the sensation of breathlessness, repositioning every 4 hours is a more direct action to support ventilation and reduce dyspnea.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Rationale:
A. Drinking an average of 2,000 milliliters of water daily is a healthy habit that promotes bowel elimination.
B. Taking a prescribed opioid pain medication at bedtime can cause constipation and impaired bowel elimination.
C. Eating apples and black-eyed peas is a healthy dietary choice that promotes bowel elimination.
D. Drinking two hot cups of coffee each morning can promote bowel elimination for some individuals.
Correct Answer is D
Explanation
Rationale:
A. While the client's feelings about never marrying are important, they do not represent an immediate health risk or safety concern.
B. Poorly fitting dentures can affect the client's quality of life and ability to eat, but they do not represent an immediate health risk or safety concern.
C. While having no living family can be a social concern, it does not represent an immediate health risk or safety concern.
D. The client being sedentary throughout most of the day is a risk factor for numerous health problems, including cardiovascular disease, obesity, and decreased mobility. It is also a modifiable risk factor that can be addressed to improve the client's health and quality of life. Encouraging the client to engage in regular physical activity is a priority.
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