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."
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Clients with OCD often engage in compulsive behaviors, such as cleaning, to manage their anxiety levels. Recognizing this can help the nurse provide appropriate support and interventions.
Choice B reason: While the tasks may seem useful, the compulsive nature of the behavior is driven by anxiety rather than a focus on productivity.
Choice C reason: The behavior is not about limiting social interaction; it is a manifestation of the client's OCD.
Choice D reason: The behavior is not intended to manipulate or control others but is a symptom of the client's OCD.
Correct Answer is A
Explanation
Choice A reason: Displacement is a defense mechanism where a person redirects a negative emotion from its original source to a less threatening recipient, which is what Mr. Thomas is doing.
Choice B reason: Projection involves attributing one's own unacceptable feelings or thoughts to others, which is not what Mr. Thomas is doing.
Choice C reason: Regression is a return to earlier stages of development when faced with stress, which does not describe Mr. Thomas's behavior.
Choice D reason: Reaction formation involves behaving in a way that is opposite to what one truly feels, which is not indicated in this scenario.
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