The nurse enters a room of a patient who is acutely short of breath. Which action should the nurse take first?

teach the patient the use of accessory muscles

ask the patient what caused the dyspnea

encourage the use of pursed lip breathing

assist the patient into a Sims position

Answer and Explanation

The Correct Answer is C

C. Pursed lip breathing is a technique that can help patients with acute dyspnea by improving ventilation, prolonging exhalation, and reducing the work of breathing. It helps to keep the airways open longer and makes it easier to get rid of excess carbon dioxide, which can provide quick relief from acute shortness of breath.
A. Teaching the patient about using accessory muscles for breathing can be beneficial in managing chronic respiratory issues, but it is not an immediate intervention.
B. Understanding the cause of dyspnea is important for treatment planning but it is not the first action to take when the patient is experiencing acute shortness of breath.
D. The Sims position, where the patient lies on their side with the lower arm behind the back and the upper leg flexed, is not typically used for relieving acute respiratory distress.

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Correct Answer is C

Explanation

C. Raisins are a source of carbohydrates, particularly simple sugars like glucose and fructose, which can quickly raise blood sugar levels during an episode of hypoglycemia. However, they do not contain protein, which can help sustain blood sugar levels over time. Raisins may provide a rapid increase in blood sugar but may not be as effective at preventing subsequent episodes of hypoglycemia.
A. Cheese is a source of protein and contains very little carbohydrate. While protein can help stabilize blood sugar levels, it may not provide a rapid increase in blood sugar during an episode of hypoglycemia. Cheese alone may not be the most effective choice for treating low blood sugar promptly.
B. Beef jerky is primarily a source of protein and may not contain enough carbohydrates to quickly raise blood sugar levels during an episode of hypoglycemia. While protein can help stabilize blood sugar over time, it may not provide the rapid increase in blood sugar needed to address acute hypoglycemia.
D. Chocolate, especially dark chocolate with a high cocoa content, contains carbohydrates in the form of sugar and fat. While it can quickly raise blood sugar levels due to its sugar content, it may not provide sustained energy due to its low protein content.

A. Consuming low-fat meats B. Drinking orange juice regularly C. Eating dinner early in the evening D. Sleeping on a large wedge-style pillow

Correct Answer is B

Explanation

B. Orange juice is highly acidic and can irritate the esophagus, leading to increased heartburn symptoms. Regular consumption of acidic beverages like orange juice can exacerbate GERD symptoms, making this a likely contributing factor to the client's heartburn.
A. Consuming low-fat meats is generally not a contributing factor to heartburn. Low-fat meats are less likely to cause reflux compared to high-fat foods, which can relax the lower esophageal sphincter and increase the risk of acid reflux.
C. Eating dinner early in the evening is generally recommended for managing GERD. This practice allows more time for the stomach to empty before lying down to sleep, reducing the likelihood of acid reflux during the night.
D. Sleeping on a large wedge-style pillow is also generally recommended for managing GERD. Elevating the head and upper body during sleep can help prevent acid from flowing back into the esophagus.

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The nurse enters a room of a patient who is acutely short of breath. Which action should the nurse take first?

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Naxlex Comprehensive Predictor Exams

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