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.
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
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. "Have you experienced anxiety or anger?": Feelings of anxiety and anger are common in anticipatory grief, but while important, they do not represent the most urgent safety concern compared to assessing for suicidal ideation.
B. "Have you been able to perform daily activities?": Evaluating functional status is important but is not the highest priority when first assessing a client’s emotional and psychological response to a terminal diagnosis.
C. "Have you had suicidal thoughts?": Assessing for suicidal ideation is the highest priority because clients facing a terminal illness may experience overwhelming despair. Ensuring the client’s immediate safety must come before addressing emotional support or coping mechanisms.
D. "Have you joined any support groups?": Participation in support groups is helpful for emotional healing, but determining the client's current mental health status and safety must be addressed before exploring support resources.
Correct Answer is C
Explanation
A. Use a gait belt during ambulation: A gait belt helps with safe ambulation but does not directly prevent footdrop, which results from muscle weakness or nerve damage when the foot remains in a pointed downward position for too long.
B. Elevate the feet while in bed: Elevating the feet may help with circulation and swelling, but it does not address the muscle weakness or nerve inactivity that can cause footdrop.
C. Begin range of motion exercises: Range of motion exercises maintain joint flexibility and muscle strength, which are essential to prevent footdrop. Moving the ankle and foot helps avoid stiffness and maintains dorsiflexion function.
D. Apply compression stockings: Compression stockings prevent blood clots and control swelling but do not prevent the muscular and neurological complications that lead to footdrop.
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