The nurse knows that teaching about the use of the incentive spirometer is effective when the client seals the lips around the mouthpiece and:

inhales slowly to raise the ball to the desired level and attempts to keep the ball raised for several seconds

blows into the mouthpiece with a long slow expiration to keep the ball at the base of the spirometer,

begins breathing with a rapid. forceful inspiration to raise the ball as high as possible.

exhales slowly to raise the ball to the desired level and quickly inhales to raise the ball again.

Answer and Explanation

The Correct Answer is A

A. Effective use of the incentive spirometer involves slow, sustained inhalation to raise the ball to the desired level and holding the breath for several seconds to fully expand the lungs.

B. Blowing into the mouthpiece is not the correct technique for using an incentive spirometer.

C. Beginning breathing with a rapid, forceful inspiration is not the correct technique for using an incentive spirometer.

D. Exhaling does not raise the ball in the incentive spirometer; it's inhalation that raises the ball to the desired level.

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Correct Answer is B

Explanation

A. Using a 1 ml syringe with a 5/8 inch needle for administering 0.5 ml of heparin subcutaneously is appropriate.

B. The instructor should intervene if the student is instructing a client to place a buccal medication under the tongue, as buccal medications should be placed in the cheek pouch, not under the tongue, which is the correct method for sublingual medications.

C. Injecting air into a vial before withdrawing medication is a standard practice to equalize pressure and facilitate withdrawal.

D. Pouring the ordered medication "Robitussin 2 tsp. now" to the 10 ml mark on a medication cup is correct since 1 tsp. is approximately 5mls.

A. Apply a sterile normal saline dressing B. Use sterile gloves to replace the protruding parts C. Administer IV antibiotics STAT D. Place the client in reverse Trendelenburg position

Correct Answer is A

Explanation

A. if a client's abdominal wound has eviscerated, the first intervention should be to apply a sterile normal saline dressing to the area and then seek immediate medical assistance.

B. Using sterile gloves to replace the protruding parts is not recommended since it can result in further damage of the organs.

C. Administering IV antibiotics may be indicated later but is not the first priority.

D. Placing the client in reverse Trendelenburg position is not the first priority and may not be appropriate for managing evisceration.

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The nurse knows that teaching about the use of the incentive spirometer is effective when the client seals the lips around the mouthpiece and:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nursing Instructor is observing a nursing student prepare and administer medications to adult clients. Which action by the nursing student requires intervention by the instructor?

Correct Answer is B

Explanation

The nurse enters a client's room to find that his abdominal wound has eviscerated. Which intervention should the nurse implement first?

Correct Answer is A

Explanation

Which one of the following blood levels would provide the nurse with the most information about the ability of the client's blood to transport oxygen? The:

In providing care for clients, the nurse knows that the normal stimulus to breathe is a/an:

The nurse recognizes that which is not a necessary feature of a team?

The nurse notes that a diuretic is listed on the client's medication administration record (MAR). It is most important for the nurse to report to the physician a serum:

The nurse recognizes that the client is manifesting early signs of hypoxia when the assessment data includes:

On admission to the hospital, the nurse notes that the client has a sacral wound that is "yellow" in color. What wound treatment would the nurse expect the health care provider to order?

Which nursing action is most helpful in thinning a client's thick respiratory secretions?