In assisting a dyspneic client with morning care, which action by the practical nurse (PN) is most important?

Schedule frequent rest periods during care.

Assist the client to a chair before making the bed.

Ask the client about his usual morning routine.

Encourage the client to participate in the care.

Answer and Explanation

The Correct Answer is A

A. Schedule frequent rest periods during care: Allowing frequent rest periods is crucial for a dyspneic client to prevent exhaustion and worsening of respiratory distress. Spacing activities conserves energy, improves oxygenation, and reduces the workload on the heart and lungs during basic care tasks.
B. Assist the client to a chair before making the bed: Moving the client to a chair may help with bed-making logistics but does not directly address the client’s immediate respiratory needs. Prioritizing respiratory support over convenience is more important in dyspneic clients.
C. Ask the client about his usual morning routine: Understanding a client’s routine can help personalize care but is not the most critical action when dyspnea is present. Ensuring that the client can safely tolerate activities without respiratory compromise takes priority.
D. Encourage the client to participate in the care: Encouragement is helpful for promoting independence but must be balanced carefully. Pushing a dyspneic client to participate too much could lead to fatigue and exacerbate respiratory symptoms

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Correct Answer is A

Explanation

A. Notify the unit charge nurse of the client's reported symptoms immediately: Tingling and numbness can be signs of hyperkalemia, a serious and potentially life-threatening complication from potassium supplementation. Immediate reporting is necessary for prompt evaluation and intervention to prevent cardiac or neuromuscular complications.
B. Reassure the client that the supplement will soon relieve those symptoms: Symptoms like tingling and numbness are not expected side effects of potassium therapy. Reassurance without investigation could delay necessary medical treatment and worsen the client’s condition.
C. Explain that a calcium supplement may be necessary: Calcium supplementation is not the standard response to symptoms of potassium imbalance. Without a clear diagnosis, recommending additional supplements could complicate the clinical situation further.
D. Encourage the client to decrease the intake of dietary sodium: Although reducing sodium is generally beneficial for health, it does not address the acute issue of possible potassium imbalance causing neuromuscular symptoms. Immediate clinical evaluation takes priority.

A. Repeat the total bed bath and complete linen change. B. Place incontinent pads around the client's buttocks. C. Cleanse any soiled skin and change the soiled linens. D. Spray a skin protectant around the perineal area.

Correct Answer is C

Explanation

A. Repeat the total bed bath and complete linen change: Repeating a full bed bath is not necessary unless the client is extensively soiled. It is more efficient and less disruptive to clean only the areas affected by incontinence while ensuring comfort and hygiene are maintained.
B. Place incontinent pads around the client's buttocks: While using incontinent pads helps manage future incontinence, it does not address the immediate need to clean the client and remove soiled linens, which is crucial to prevent skin breakdown and infection.
C. Cleanse any soiled skin and change the soiled linens: Cleaning the soiled skin and changing the linens is the best immediate response to maintain skin integrity, prevent infection, and promote client comfort. This targeted approach ensures the client remains clean without unnecessary interventions.
D. Spray a skin protectant around the perineal area: Applying a skin protectant is a helpful preventive measure after cleansing, but it should not be the first step. The priority is to remove feces and soiled linens before considering protective applications to the skin.

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In assisting a dyspneic client with morning care, which action by the practical nurse (PN) is most important?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

One week after beginning a new prescription for potassium chloride, a client tells the practical nurse (PN) that there is tingling and numbness in the feet and hands. Which action should the PN take?

Correct Answer is A

Explanation

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Correct Answer is C

Explanation

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