The nurse is caring for a client diagnosed with acute respiratory failure as a result of right middle and lower lobe pneumonia. To optimize ventilation and secretion removal the nurse should position the client:

in the prone position.

in high-Fowler's position.

on the left side.

on the right side.

Answer and Explanation

The Correct Answer is D

A. In the prone position:
The prone position has been shown to be beneficial in certain respiratory conditions, particularly in acute respiratory distress syndrome (ARDS), where it can help improve oxygenation by redistributing blood flow in the lungs. However, prone positioning is typically not the first choice for pneumonia, especially when it is localized to specific lobes of the lung. It is more commonly used in cases of diffuse bilateral lung injury or severe hypoxemia. Therefore, while prone positioning can improve oxygenation in ARDS, it is not specifically targeted for secretion removal in localized pneumonia.

B. In high-Fowler's position:
The high-Fowler's position (sitting up at a 60-90 degree angle) can help with dyspnea and promote lung expansion in conditions like heart failure or dyspneic states. However, for pneumonia, it is not as effective as lateral positioning for facilitating secretion drainage from specific lung lobes. The high-Fowler's position may be useful for promoting overall comfort and reducing dyspnea, but it is not the best position for improving secretion removal from the right middle and lower lobes.

C. On the left side:
Positioning the patient on the left side is not ideal for right middle and lower lobe pneumonia, as it would not optimize drainage from the affected lobes. The right middle and lower lobes are better drained when the patient is positioned on the right side, as gravity can help move the secretions from the affected lobes toward the larger airways for easier clearance.

D. On the right side: In the case of right middle and lower lobe pneumonia, positioning the client on the right side can help optimize ventilation and promote better secretion removal from the affected areas of the lung. This position allows gravity to assist in draining secretions from the right middle and lower lobes toward the larger airways, where they can be more easily cleared by coughing or suctioning. This positioning can improve oxygenation and facilitate secretion management, which is crucial for improving respiratory function in pneumonia.

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Correct Answer is D

Explanation

A. Resume smoking initially to help manage stress and anxiety:
Smoking is a significant risk factor for cardiovascular disease and can worsen the prognosis after coronary artery bypass graft (CABG) surgery. Smoking increases the risk of coronary artery disease and impairs healing after surgery. Therefore, advising the client to resume smoking, even temporarily, is unsafe and completely contrary to health recommendations for post-CABG care. Smoking cessation should be emphasized as a key part of the recovery process.

B. Consume a high-fat diet to promote weight gain and energy:
A high-fat diet is not recommended for individuals with coronary artery disease, especially after CABG surgery. Consuming a diet high in saturated fats and cholesterol can lead to further plaque buildup in the coronary arteries, increasing the risk of atherosclerosis and cardiac events. After CABG, patients are typically encouraged to follow a heart-healthy diet that is low in saturated fat, high in fiber, and rich in fruits, vegetables, and lean proteins to support overall heart health and recovery.

C. Avoid physical activity and rest as much as possible:
While rest is essential immediately following surgery, complete avoidance of physical activity is not advisable long-term. In fact, early and gradual physical activity is a key component of rehabilitation after CABG surgery. A sedentary lifestyle can increase the risk of complications such as blood clots, muscle weakness, and weight gain, while physical activity helps improve circulation, heart function, and overall recovery. The nurse should encourage the client to gradually resume physical activity according to the guidance of their healthcare provider, often starting with light walking and progressing as tolerated.

D. Continue taking all prescribed medications as directed: Following coronary artery bypass graft (CABG) surgery, it is essential for the client to continue taking all prescribed medications, including antiplatelets, statins, beta-blockers, and any other medications ordered by the healthcare provider. These medications play a critical role in preventing blood clots, controlling blood pressure, reducing cholesterol levels, and preventing future cardiac events. Stopping or altering medications without consulting a healthcare provider could increase the risk of complications or recurrent cardiac events.

A. Guidewire-induced dysrhythmia B. Pneumothorax C. Pulmonary infarction D. Venous thrombosis

Correct Answer is B

Explanation

A. Guidewire-induced dysrhythmia: Guidewire-induced dysrhythmia can occur if the guidewire or catheter irritates the heart during insertion, particularly when the catheter is placed in the central venous system. While this can lead to arrhythmias, it is typically more immediate and occurs during the procedure itself. The symptoms of dysrhythmia (e.g., irregular heartbeat) would more likely present right after insertion or during the manipulation of the guidewire. The signs of restlessness, JVD, and tachycardia observed 30 minutes after placement are more suggestive of a pneumothorax than of a guidewire-induced dysrhythmia.

B. Pneumothorax: Pneumothorax is a potential complication of central venous catheter (CVC) placement, particularly when the catheter is inserted into the subclavian vein. The right subclavian vein is located near the apex of the lung, so inadvertent puncture of the lung during catheter placement can lead to air entering the pleural space, causing a pneumothorax. The symptoms of pneumothorax may include restlessness, tachycardia, jugular vein distention (JVD), and respiratory distress. A heart rate of 120 beats per minute is consistent with tachycardia due to hypoxia or distress, and JVD can be a sign of increased intrathoracic pressure or impaired venous return, which occurs with a pneumothorax. These symptoms warrant immediate assessment for pneumothorax, which can be confirmed with a chest x-ray.

C. Pulmonary infarction: Pulmonary infarction occurs when a blockage in the pulmonary arteries prevents blood flow to lung tissue, resulting in tissue death. This can be caused by a pulmonary embolism or other issues, but it is not a typical complication of central venous catheter placement. The symptoms described (restlessness, JVD, and tachycardia) are more consistent with a pneumothorax than a pulmonary infarction, which would likely cause chest pain, hemoptysis, or dyspnea rather than these signs.

D. Venous thrombosis: While venous thrombosis (or clot formation) is a potential complication of central venous catheter placement, it typically manifests as swelling, redness, or pain at the catheter insertion site, rather than with the systemic symptoms of restlessness, tachycardia, and JVD. Venous thrombosis could cause some of the described symptoms in the long term, but it is less likely to be the cause of acute symptoms 30 minutes post-procedure. The immediate concern in this case is more likely to be pneumothorax, which can occur more suddenly and cause these symptoms.Top of FormBottom of Form

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Arterial Blood Gases
pH	7.35-7.45
PaCO2	35-45mmHg
PaO2	80-100mmHg
HCO3-	22-26 mEq/L
O2 Saturation	>95%
Chemistry
BUN	8-21mg/dl
Creatinine	0.5-1.2mg/dl
Na	135-145 mEq/L
K	3.5-5.3 mEq/L
Cl	97-107 mEq/L
CO2	22-26 mEq/L
Ca	8.2-10.2 mg/dl
Glucose	65-99 mg/dl
Mg	1.7-2.2 mg/dl
PO4	2.5-4.5 mg/dl

The nurse is caring for a client diagnosed with acute respiratory failure as a result of right middle and lower lobe pneumonia. To optimize ventilation and secretion removal the nurse should position the client:

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Correct Answer is D

Explanation

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Explanation

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