A patient who is terminally ill is described during shift report as having Cheyne-Stokes breathing. On assessment, the nurse anticipates finding:

respirations gradually decreasing in rate and depth.

rapid wheezing respirations for two or three breaths with short periods of apnea.

a breathing pattern of dyspnea followed by a short period of apnea.

quick shallow respirations with long periods of apnea.

Answer and Explanation

The Correct Answer is C

A.   Gradual decreases in rate and depth are typically seen in other respiratory conditions, not Cheyne- Stokes breathing.
B.   Wheezing is not associated with Cheyne-Stokes breathing but may be related to airway obstructions or lung conditions.
C.   Cheyne-Stokes breathing is characterized by a pattern of deep, rapid breathing followed by a period of apnea, commonly seen in terminally ill patients.
D.   Quick shallow respirations with long periods of apnea are not characteristic of Cheyne-Stokes breathing.

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Correct Answer is D

Explanation

A. Rinsing the thermometer with water is not necessary to ensure an accurate reading. The thermometer should be cleaned after use but rinsing with water does not directly ensure accuracy.
B. Using a dry cotton ball to dry the thermometer is unnecessary and could leave fibers on the device that may interfere with reading accuracy.
C. Wiping the thermometer with alcohol helps sanitize it but does not directly influence the accuracy of the reading.
D. Shaking down the galinstan alloy to below normal is necessary to reset the thermometer before use, ensuring that the mercury level is accurate when taking a new temperature.

A. allow the patient to sit on the side of the bed for a minute before standing. B. instruct the patient to use the wheelchair for all mobility activity. C. keep the patient in bed in a high Fowler's position D. help the patient to rise quickly and support the patient for a minute.

Correct Answer is A

Explanation

A. Allowing the patient to sit on the side of the bed helps to prevent sudden drops in blood pressure and allows the body to adjust to the change in position, reducing the risk of fainting or dizziness.
B. Using a wheelchair for mobility may not address the root cause of orthostatic hypotension and may limit the patient's independence.
C. Keeping the patient in a high Fowler's position could worsen the symptoms of orthostatic hypotension.
D. Rising quickly could lead to a sudden drop in blood pressure and increase the risk of a fall or injury.

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A patient who is terminally ill is described during shift report as having Cheyne-Stokes breathing. On assessment, the nurse anticipates finding:

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Naxlex Comprehensive Predictor Exams

To ensure an accurate reading when using a glass oral thermometer, it is necessary to

Correct Answer is D

Explanation

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Correct Answer is A

Explanation

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