A nurse is teaching a client who has pneumonia about the use of an incentive spirometer. Which of the following instructions should the nurse Include?

"Tilt the spirometer toward yourself so you can see the balls rise."

"Inhale deeply and hold each breath for a minimum of 10 seconds."

"Exhale before sealing your lips around the mouthpiece."

"Use your incentive spirometer every 4 hours while you are awake."

Answer and Explanation

The Correct Answer is D

A) "Tilt the spirometer toward yourself so you can see the balls rise": Tilting the spirometer is not necessary and may affect its accuracy. The spirometer should be held in an upright position to ensure correct measurement of inhalation.

B) "Inhale deeply and hold each breath for a minimum of 10 seconds": Inhaling deeply is important, but holding each breath for 10 seconds is not a typical recommendation for using an incentive spirometer. The goal is to inhale deeply and slowly, without necessarily holding the breath for an extended period.

C) "Exhale before sealing your lips around the mouthpiece": Exhaling before using the spirometer is not recommended. The correct procedure involves inhaling deeply and slowly after sealing your lips around the mouthpiece to ensure accurate measurement and effective lung expansion.

D) "Use your incentive spirometer every 4 hours while you are awake": Frequent use of the incentive spirometer, often every hour while awake, is recommended to improve lung function and prevent complications such as atelectasis. Using it every 4 hours may not be sufficient for effective respiratory therapy.

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Correct Answer is A

Explanation

A) Impaired coordination:
Impaired coordination is a common manifestation of hypothermia. As the body temperature drops, the nervous system is affected, leading to difficulties in motor control and coordination. This symptom is indicative of the body's struggle to maintain normal physiological functions in response to the cold.

B) Sensitivity to light:
Sensitivity to light is not typically associated with hypothermia. This symptom is more commonly related to conditions affecting the eyes or the central nervous system, such as migraines or meningitis.

C) Increased respiratory rate:
Hypothermia generally leads to a decreased respiratory rate as the body's metabolic processes slow down. An increased respiratory rate is not a common symptom and may indicate another underlying condition or a compensatory mechanism for another issue.

D) Hypertension:
Hypertension is not a typical manifestation of hypothermia. In fact, as hypothermia progresses, the body's blood pressure often decreases due to reduced cardiac output and peripheral vasoconstriction.

A. Staying current on scheduled immunizations B. Maternal smoking during pregnancy C. Newborn who is large for gestational age D. Meconium staining of amniotic fluid

Correct Answer is B

Explanation

A) Staying current on scheduled immunizations: While important for overall child health, staying current on immunizations is not a direct risk factor for sudden infant death syndrome (SIDS). Immunizations help prevent infections but do not specifically impact the likelihood of SIDS.

B) Maternal smoking during pregnancy: Maternal smoking during pregnancy is a significant risk factor for SIDS. Tobacco smoke exposure can negatively impact the baby's respiratory system and increase the risk of SIDS, making it crucial to address this risk factor.

C) Newborn who is large for gestational age: Being large for gestational age is not a recognized risk factor for SIDS. Risk factors for SIDS are more associated with environmental and prenatal conditions rather than birth weight alone.

D) Meconium staining of amniotic fluid: Meconium staining indicates potential fetal distress and complications during labor but is not a direct risk factor for SIDS. It is more related to the conditions surrounding birth rather than the risk of SIDS.

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A nurse is teaching a client who has pneumonia about the use of an incentive spirometer. Which of the following instructions should the nurse Include?

Nursing Test Bank

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Correct Answer is A

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Correct Answer is B

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