The nurse encourages the 84-year-old patient who is recovering from a hip replacement to:
Keep the bed flat to aid in lung expansion.
Cough frequently to make up for the loss of cilia.
Encourage bed rest.
Restrict fluid to prevent pulmonary congestion.
The Correct Answer is B
Choice A rationale
Keeping the bed flat does not necessarily aid lung expansion and can sometimes increase the risk of aspiration in patients with compromised mobility or cognition.
Choice B rationale
Encouraging the patient to cough frequently helps clear secretions from the lungs, compensating for the diminished function of cilia in elderly patients.
Choice C rationale
Encouraging bed rest can lead to complications such as muscle atrophy, decreased lung capacity, and increased risk of pressure ulcers in elderly patients.
Choice D rationale
Restricting fluid intake to prevent pulmonary congestion is not generally recommended unless there is a specific medical condition requiring fluid restriction, as adequate hydration is vital for overall health.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
A 10% solution of chlorine bleach is an effective disinfectant for contaminated areas in the home. Chlorine bleach has broad-spectrum antimicrobial properties, making it suitable for killing various pathogens, including bacteria and viruses.
Choice B rationale
Soaking in a solution of povidone iodine for 30 minutes and rinsing with hot water is not practical for home disinfection. While povidone iodine is effective as a disinfectant, it is typically used for medical purposes and not for cleaning household surfaces.
Choice C rationale
A 12% solution of alcohol is not as effective as a 10% solution of chlorine bleach for disinfecting contaminated areas in the home. Alcohol concentrations above 70% are generally more effective for disinfection purposes.
Choice D rationale
Covering the area with boiling water and letting it air dry is not a reliable method for disinfecting contaminated areas. Boiling water may not effectively kill all pathogens, and this method lacks the broad-spectrum efficacy of chemical disinfectants.
Correct Answer is B
Explanation
Choice A rationale
Using gowns, gloves, and masks for any family contact with the patient is more stringent than necessary for home care. It would not be practical or necessary for family members and may create unnecessary barriers.
Choice B rationale
Maintaining medical asepsis and proper handling of contaminated dressings is essential to prevent the spread of infection. This involves proper hand hygiene, using clean dressings, and disposing of contaminated materials correctly.
Choice C rationale
Washing hands thoroughly before the dressing change is crucial but not enough on its own to prevent the spread of infection. It must be combined with other aseptic techniques.
Choice D rationale
Having the patient be the only person to perform dressing changes does not eliminate the risk of infection to family members, as they may still come into contact with contaminated materials.
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