A nursing student is assessing a postoperative client who has developed bilateral pneumonia. The nursing plan of care includes positioning the client in the semi-Fowler’s position, elevating the head of the bed from 30 degrees to 45 degrees.
What is the rationale for this position?
It facilitates nursing assessments of skin color and temperature.
The client will be more comfortable and have less thoracic pain.
It promotes full expansion of the lung fields.
It increases blood flow to the heart.
The Correct Answer is C
Choice A rationale:
While elevating the head of the bed can make it easier to visualize the patient's face and upper chest, it's not the primary rationale for positioning a patient with pneumonia in semi-Fowler's position.
Skin color and temperature can be assessed in other positions as well, such as supine or side-lying. In cases of pneumonia, prioritizing respiratory function takes precedence over ease of skin assessment. Choice B rationale:
While semi-Fowler's position can offer some comfort, it's not the most comfortable position for all patients, especially those with thoracic pain.
Positions that fully support the back and minimize pressure on the chest, such as side-lying with pillows, may provide better pain relief.
The primary goal in positioning a patient with pneumonia is to optimize respiratory function, not solely to maximize comfort.
Choice C rationale:
Semi-Fowler's position effectively promotes lung expansion due to the following reasons:
Gravity: Elevating the head of the bed allows gravity to assist in pulling the diaphragm downward, creating more space for lung expansion.
Abdominal pressure: The semi-upright position reduces pressure from the abdominal organs on the diaphragm, further facilitating its downward movement and enhancing lung expansion.
Secretion drainage: The inclined position encourages drainage of secretions from the upper airways, preventing their accumulation and potential airway obstruction. This allows for better air entry and gas exchange.
Choice D rationale:
While semi-Fowler's position may slightly increase venous return to the heart, it's not the primary reason for using this position in patients with pneumonia.
Positions that significantly increase venous return, such as Trendelenburg position (head down), are typically used for specific indications like shock or hypotension, not for pneumonia management.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Sims' position is a side-lying position with the lower leg flexed and the upper leg extended. It is not ideal for bladder scanning because it can compress the bladder and make it difficult to obtain an accurate reading.
Additionally, in Sims' position, the bladder may not be fully accessible to the scanner, as it may be partially obscured by the upper thigh.
Choice B rationale:
Dorsal recumbent position is the optimal position for bladder scanning. In this position, the client lies flat on their back with their knees bent and their feet flat on the bed. This position allows for:
Full exposure of the bladder, making it easily accessible to the scanner.
Relaxation of the abdominal muscles, which can help to ensure an accurate reading.
A comfortable position for the client, promoting cooperation and reducing the likelihood of movement that could interfere with the scan.
Choice C rationale:
Supine position is a similar position to dorsal recumbent, but with the legs fully extended. While it is possible to perform a bladder scan in this position, it is not as ideal as dorsal recumbent because:
The extended legs can place some tension on the abdominal muscles, potentially affecting bladder position and the scan's accuracy.
The client may find this position less comfortable, leading to restlessness and potential movement that could interfere with the scan.
Choice D rationale:
High Fowler's position is a semi-sitting position with the head of the bed elevated at a 45- to 60-degree angle. This position is not suitable for bladder scanning because:
Gravity can pull the bladder downwards, making it difficult to visualize and measure accurately.
It can be challenging to maintain proper positioning of the scanner on the abdomen in this position, potentially leading to inaccurate readings.
Correct Answer is D
Explanation
Choice A rationale:
Planning is conducted during the initial stage of Lewin's change model, known as the unfreezing phase. This phase involves creating awareness of the need for change, building support, and developing a plan for implementation. It's not part of the refreezing phase.
Choice B rationale:
Change is initiated during the second stage of Lewin's change model, known as the change or transition phase. This phase involves implementing the planned changes, providing training and support, and addressing resistance. It's not part of the refreezing phase.
Choice C rationale:
The need for change is recognized during the unfreezing phase, not the refreezing phase. Recognizing the need for change is a crucial step in initiating the change process, but it's not the focus of the refreezing phase.
Choice D rationale:
Change becomes permanent during the refreezing phase. It involves solidifying the new behaviors and practices that have been implemented during the change phase. This is achieved through various strategies, such as:
Reinforcement of the new behaviors through rewards, recognition, and positive feedback
Integration of the new behaviors into organizational policies, procedures, and structures
Creation of a supportive culture that encourages and sustains the change
Ongoing monitoring and evaluation to ensure that the change is sustained over time
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