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 C

Explanation

A) Weight gain: Weight gain is more commonly associated with right-sided heart failure due to fluid retention and peripheral edema. While left-sided heart failure can lead to overall heart failure, causing weight gain, it is not as specific as breathlessness for left-sided failure.

B) Warm extremities after walking: Warm extremities are generally a sign of good circulation. In clients with left-sided heart failure, reduced cardiac output often leads to poor peripheral circulation, which would more likely cause cool extremities.

C) Breathlessness when carrying an object: Left-sided heart failure leads to decreased cardiac output and pulmonary congestion. As a result, clients often experience breathlessness or dyspnea, especially during physical activities, because the heart cannot efficiently pump blood, leading to fluid buildup in the lungs.

D) Increased urinary output during the day: Left-sided heart failure usually causes decreased renal perfusion, leading to reduced urinary output during the day. Clients might experience nocturia (increased nighttime urination) due to fluid reabsorption when lying down, but increased daytime output is not typical.

A. "I will rotate the earmold forward when I insert my hearing aid." B. "If my hearing aid gets dirty, I can clean it with alcohol swabs." C. "I should turn the hearing aid on before I insert it." D. "If my hearing aid whistles, I should change the battery."

Correct Answer is A

Explanation

A) Rotating the earmold forward when inserting the hearing aid is a correct technique. This ensures a proper fit and helps to position the hearing aid comfortably in the ear canal, which can enhance the effectiveness and comfort of the device.

B) Cleaning the hearing aid with alcohol swabs can damage the delicate components of the device. Instead, hearing aids should be cleaned with a dry cloth or a soft brush specifically designed for this purpose to avoid damaging the hearing aid.

C) Turning the hearing aid on before inserting it may result in feedback or a whistling sound. It's usually recommended to insert the hearing aid first and then turn it on to avoid any discomfort or unwanted noise.

D) If the hearing aid whistles, it is not typically related to the battery. Whistling is often caused by improper fit, earwax buildup, or feedback issues. Changing the battery is unlikely to resolve the whistling problem and is not the recommended solution.

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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?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is A

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