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

restlessness, confusion, tachycardia.

bradycardia, dyspnea, cyanosis.

hypotension, vomiting, cyanosis.

bradycardia, lethargy, confusion.

Answer and Explanation

The Correct Answer is A

Choice A rationale: Restlessness, confusion, and tachycardia are early signs of hypoxia, indicating inadequate oxygenation.

Choice B rationale: Bradycardia, dyspnea, and cyanosis are more indicative of advanced hypoxia.

Choice C rationale: Hypotension, vomiting, and cyanosis may suggest severe hypoxia or other medical issues but are not typically early signs.

Choice D rationale: Bradycardia, lethargy, and confusion are not typical early signs of hypoxia.

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Correct Answer is ["B","D","E"]

Explanation

Choice A rationale: Hypernatremia involves elevated sodium levels, so encouraging potassium-rich foods is not directly related to addressing hypernatremia.

Choice B rationale: Restricting sodium in the diet is appropriate to help manage and reduce hypernatremia. This can prevent further complications of hypernatremia, such as dehydration, confusion, seizures, and coma.

Choice C rationale: This is not an appropriate intervention for hypernatremia, as water intake can help dilute the sodium levels and restore the fluid balance in the body.

Decreasing water intake can worsen the hypernatremia and cause dehydration. Choice D rationale: This is an appropriate intervention for hypernatremia, as high sodium levels can affect the fluid balance and blood pressure in the body. Monitoring

vital signs can help detect any changes or abnormalities that may indicate worsening of the condition or need for further treatment.

Choice E rationale: Monitoring intake and output helps assess fluid balance and response to interventions for hypernatremia.

A. inhales slowly to raise the ball to the desired level, and attempts to keep the ball raised for several seconds B. blows into the mouthpiece with a long slow expiration to keep the ball at the base of the spirometer. C. begins breathing with a rapid, forceful inspiration to raise the ball as high as possible. D. exhales slowly to raise the ball to the desired level, and quickly inhales to raise the ball again.

Correct Answer is A

Explanation

Choice A rationale: Inhaling slowly to raise the ball to the desired level and attempting to keep the ball raised for several seconds is the correct technique for using an incentive spirometer.

Choice B rationale: Blowing into the mouthpiece with a long slow expiration is not the correct technique for using an incentive spirometer.

Choice C rationale: Beginning breathing with a rapid, forceful inspiration is not the recommended technique for using an incentive spirometer.

Choice D rationale: Exhaling slowly to raise the ball and quickly inhaling is not the correct technique for using an incentive spirometer.

View Question and Answer

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

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client being treated for hypernatremia. Which of the following are appropriate nursing interventions? (SELECT ALL THAT APPLY)

Correct Answer is ["B","D","E"]

Explanation

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

Correct Answer is A

Explanation

A client must receive eyedrops bilaterally four times a day. The medication should be dropped onto which of the following areas?

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An advantage of delegation in client care is that:

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The best way for the nurse to assess a client's level of dyspnea is to: