The nurse is preparing to administer a narcotic analgesic to a client with a fractured femur who also has obstructive sleep apnea (OSA). Which intervention is most important for the nurse to implement?
Remove dentures or other oral appliance.
Elevate the head of the bed to a 45-degree angle.
Lift and lock the side rails in place.
Apply the client's positive airway pressure device.
The Correct Answer is D
A. Removing dentures or other oral appliances is not directly related to managing obstructive sleep apnea. While it may be necessary for certain procedures or assessments, it does not address the client's OSA during narcotic administration.
B. Elevating the head of the bed to a 45-degree angle is a standard practice to prevent aspiration during narcotic administration, but it does not specifically address the client's obstructive sleep apnea.
C. Lifting and locking the side rails in place is important for client safety but does not directly address the client's obstructive sleep apnea.
D. Applying the client's positive airway pressure (PAP) device is crucial for managing obstructive sleep apnea, especially when administering a narcotic analgesic, which can further depress respiratory function. The PAP device helps maintain airway patency and prevent apneic episodes, reducing the risk of respiratory complications in clients with OSA.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Self-care deficit relative to motor disturbance. While self-care deficit is a concern for clients with Parkinson's disease due to motor disturbances, the highest priority is addressing the risk for aspiration to prevent potential life-threatening complications such as aspiration pneumonia.
B. Risk for aspiration relative to muscle weakness. Parkinson's disease can cause muscle weakness and impaired swallowing function, leading to an increased risk of aspiration.
Aspiration pneumonia is a severe complication that requires immediate attention, making this the highest priority nursing problem.
C. Risk for constipation relative to immobility. Constipation is a common problem in Parkinson's disease due to immobility and medication side effects. While constipation should be addressed, it is not as immediately life-threatening as the risk for aspiration.
D. Impaired physical mobility relative to muscle rigidity. Impaired physical mobility is a significant concern in Parkinson's disease, but muscle rigidity does not necessarily pose an
immediate risk of aspiration. Addressing impaired mobility is important for maintaining overall function and quality of life but may not be the highest priority in this scenario.
Correct Answer is C
Explanation
A. Encouraging the client to participate in a team sport may be overwhelming and unrealistic given the client's current level of depression and lack of activity. Starting with smaller, more achievable goals is essential in the initial stages of treatment.
B. Helping the client develop a list of daily affirmations is a positive intervention for promoting self-esteem, but it may not address the immediate need for increasing activity levels or engagement in meaningful activities.
C. Assisting the client in identifying goals for the day is the most important intervention at this stage. Setting achievable daily goals can help the client regain a sense of purpose and motivation. These goals should be realistic and tailored to the client's current abilities and interests.
D. Scheduling the client for a group focusing on self-esteem is beneficial, but it may not directly address the client's need for increased activity and engagement in meaningful daily activities.
Goals related to self-esteem can be incorporated into the client's plan of care but should be part of a comprehensive approach to treatment.
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