In preparation for ambulation, the nurse plans to assist a postoperative client in transitioning from a lying to a sitting position. Which nursing action is most appropriate to maintain the client's safety?

Assess the client for signs of dizziness and hypotension

Assist the client to move quickly from the lying position to the sitting position

Elevate the head of the bed quickly to assist the client to a sitting position

Allow the client to rise from the bed to a standing position unassisted

Answer and Explanation

The Correct Answer is A

A. Assessing for dizziness and hypotension helps prevent falls and complications related to orthostatic changes during position changes.
B. Moving quickly increases the risk of dizziness and falls, which is unsafe.
C. Elevating the head of the bed quickly can cause sudden blood pressure drops and dizziness.
D. Allowing the client to stand unassisted postoperatively is unsafe due to potential weakness or hypotension.

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Free Nursing Study Resources

Correct Answer is A

Explanation

A. Metformin is withheld before and after contrast studies to reduce the risk of lactic acidosis if kidney function is impaired.
B. Glipizide does not have this contraindication with contrast media.
C. Insulin therapy is adjusted based on blood glucose levels and is not routinely withheld.
D. Repaglinide is not contraindicated with contrast agents and does not require withholding.

A. Keep a loose seal between the lips and the mouthpiece. B. Inhale as rapidly as possible. C. After maximum inspiration, hold the breath for 20 seconds and exhale. D. The best results are achieved when sitting up or with the head of the bed elevated 45 to 90 degrees.

Correct Answer is D

Explanation

A. A tight seal between the lips and mouthpiece is necessary to effectively use the incentive spirometer.
B. Inhalation should be slow and deep, not rapid, to maximize lung expansion.
C. The breath should be held for about 3 to 5 seconds, not 20 seconds, to prevent dizziness.
D. Sitting up or elevating the head of the bed improves lung expansion and enhances the effectiveness of the incentive spirometer.

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In preparation for ambulation, the nurse plans to assist a postoperative client in transitioning from a lying to a sitting position. Which nursing action is most appropriate to maintain the client's safety?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is scheduled for a CT scan with contrast. Which medication must be withheld 24-48 hours before and restarted 48 hours after the procedure?

Correct Answer is A

Explanation

The nurse is preparing a preoperative teaching plan about using an incentive spirometer. Which of the following should the nurse include in the teaching plan?

Correct Answer is D

Explanation

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