The nurse is caring for a client diagnosed with pneumonia. Which interventions should the nurse include in the plan of care? (Select All that Apply.)

Plan for periods of rest during activities, Monitoring the client's oxygen saturation

Place the client on strict fluid restriction

Placing the client on oxygen

Restrict the client's smoking to 5 cigarettes per day

Answer and Explanation

Correct Answer : A,C

A. Planning for periods of rest during activities and monitoring the client's oxygen saturation are essential interventions for a client with pneumonia. Rest helps conserve energy and reduces the workload on the respiratory system, while monitoring oxygen saturation ensures that the client is maintaining adequate oxygen levels, which is crucial in pneumonia.
B. Placing the client on strict fluid restriction is not appropriate for pneumonia. In fact, adequate hydration is important to help thin respiratory secretions and facilitate expectoration.
C. Placing the client on oxygen is often necessary for clients with pneumonia, especially if they are hypoxic or have difficulty maintaining adequate oxygen levels. Supplemental oxygen supports the respiratory system and improves oxygenation.
D. Restricting the client's smoking to 5 cigarettes per day is not an appropriate intervention. Smoking should be completely stopped to help reduce the risk of further respiratory complications. Smoking cessation is a priority in managing respiratory conditions like pneumonia

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Correct Answer is C

Explanation

A. It is appropriate to notify the physician if bright red blood is found in the NG tube, as this could indicate bleeding, which requires prompt medical attention.
B. It is standard practice to keep the NG tube taped and secured to the patient’s nares to prevent dislodgement and ensure proper function.
C. A temperature under 100.5°F is generally not a cause for concern postoperatively, unless it is persistent or accompanied by other signs of infection. Typically, a low-grade fever is expected after surgery, but further investigation is only warranted for higher fevers or other concerning symptoms.
D. Irrigating the NG tube every 6 hours with 30 mL of normal saline is standard practice to ensure patency of the tube and prevent clogging.

A. "I will sleep on my stomach with my head flat." B. "I will lie on my right side to sleep at night." C. "I will sleep on my back with my head flat." D. "I will lie on my left side to sleep at night."

Correct Answer is D

Explanation

A. Sleeping on the stomach is not recommended for patients with GERD because it can increase pressure on the stomach, promoting acid reflux.
B. Lying on the right side can actually worsen GERD symptoms because it allows acid to flow more easily into the esophagus from the stomach, due to the positioning of the stomach and esophagus.
C. Sleeping on the back with the head flat does not provide sufficient elevation to prevent acid reflux, which can lead to symptoms worsening during the night.
D. Sleeping on the left side helps reduce the likelihood of acid reflux. This position prevents the stomach's contents from moving up into the esophagus, making it the most effective sleeping position for GERD.

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The nurse is caring for a client diagnosed with pneumonia. Which interventions should the nurse include in the plan of care? (Select All that Apply.)

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Naxlex Comprehensive Predictor Exams

A patient has a nasogastric (NG) tube following esophagectomy. Following standards of practice, which of the following postoperative instructions should the nurse question the surgeon about?

Correct Answer is C

Explanation

A nurse is instructing a client who has GERD about positions that can help minimize the effects of reflux during sleep. Which of the following statements indicates to the nurse that the client understands the instructions?

Correct Answer is D

Explanation

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