A nurse is reinforcing teaching with a client who is preoperative following abdominal surgery about deep breathing and coughing exercises. Which of the following client statements should indicate to the nurse an understanding of the instructions?

"I start to use the incentive spirometer when I can get out of bed."

"I breathe deeply and cough every 4 hours."

"I splint my incision with a pillow to cough."

"I lie flat in bed to cough and deep breathe."

Answer and Explanation

The Correct Answer is C

Choice A reason: Using the incentive spirometer is important, but it is not specifically related to deep breathing and coughing exercises.

Choice B reason: Breathing deeply and coughing every 4 hours is part of postoperative care, but it does not indicate understanding of the technique to protect the incision.

Choice C reason: Splinting the incision with a pillow while coughing is a recommended technique to support the incision and reduce pain during coughing, indicating an understanding of the instructions.

Choice D reason: Lying flat is not recommended for deep breathing and coughing exercises as it can inhibit lung expansion and is not conducive to effective coughing.

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

Explanation

Choice A reason: A bounding pulse can indicate fluid volume excess, as the heart works harder to pump the increased volume.

Choice B reason: Elevated temperature is not specifically indicative of fluid volume excess and can be related to various conditions.

Choice C reason: Warmth at the IV site may indicate an infection or inflammation, not necessarily fluid volume excess.

Choice D reason: Profuse sweating is not typically a sign of fluid volume excess; instead, it may indicate dehydration or other conditions.

Choice E reason: Crackles in the lungs can indicate fluid overload, especially in the context of excessive IV fluid administration.

A. Phobia B. Post-Traumatic Stress Disorder (PTSD) C. Somatic Symptom Disorder (SSD) D. Generalized Anxiety Disorder (GAD)

Correct Answer is C

Explanation

Choice A reason: Phobia is an anxiety disorder characterized by an excessive and irrational fear of specific objects, situations, or activities, which does not align with Ms. T's symptoms.

Choice B reason: PTSD is a disorder that can occur after a person has been through a traumatic event, which is not indicated in Ms. T's case.

Choice C reason: SSD is characterized by an extreme focus on physical symptoms, such as pain, that causes major emotional distress and problems functioning, which matches Ms. T's experience.

Choice D reason: GAD involves persistent and excessive worry about various things, not just physical symptoms, so it is less likely than SSD in this scenario.

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A nurse is reinforcing teaching with a client who is preoperative following abdominal surgery about deep breathing and coughing exercises. Which of the following client statements should indicate to the nurse an understanding of the instructions?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient is receiving IV fluids at 100 mL per hour. Which assessment findings would indicate fluid volume excess? (Select all that apply.)

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

Explanation

Ms. T complains of headaches and body pains whenever her husband mentions that the house needs to be cleaned. This has been a recurring problem for more than 6 months. Ms. T probably is suffering from what kind of disorder?

Correct Answer is C

Explanation

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Debridement is:

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We encourage the patient to cough and deep breathe after surgery to prevent: