Which intervention would be appropriate for a client with shortness of breath?

Maintain the patient in a supine position during rest.

Monitor the client's oxygen saturation hourly.

Ambulate the client in the hall four times daily.

Encourage high protein foods during mealtime.

Answer and Explanation

The Correct Answer is B

Choice A rationale:

Maintaining the patient in a supine position during rest would not be appropriate for a client with shortness of breath. This position can worsen breathing difficulties, especially in clients with respiratory issues. It reduces lung expansion and can lead to increased work of breathing.

Choice B rationale:

Monitoring the client's oxygen saturation hourly is the appropriate intervention for a client with shortness of breath. Oxygen saturation (SpO2) levels indicate the percentage of oxygen bound to hemoglobin in the blood. Monitoring SpO2 levels helps assess the client's oxygenation status and provides crucial information about the effectiveness of respiratory interventions. Normal oxygen saturation levels typically range between 95% to 100%. Monitoring allows timely recognition of hypoxemia, enabling prompt intervention to improve oxygenation and prevent complications.

Choice C rationale:

Ambulating the client in the hall four times daily may not be suitable for a client experiencing shortness of breath, as it can exacerbate respiratory distress. Ambulation increases oxygen demand and can further compromise oxygenation in individuals struggling to breathe.

Choice D rationale:

Encouraging high protein foods during mealtime is unrelated to the immediate management of shortness of breath. While proper nutrition is essential for overall health and healing, it does not directly address the acute issue of respiratory distress.

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Free Nursing Study Resources

Correct Answer is D

No explanation

A. The patient's nurse asks the patient if their neighbor, who is at the nurses station, can visit now. B. The patient's nurse uses the facility computer to document the patient's bath and linen change. C. A nurse looks at the chart of their neighbor so that the nurse can add them to the prayer list at church. D. A nurse fails to log off the computer charting system after documenting patient care. E. A nurse discusses a patient with a coworker in the elevator.

Correct Answer is ["C","D"]

Explanation

Choice A rationale:

Asking a patient if their neighbor can visit is not a violation of HIPAA policy as it does not involve sharing sensitive patient information.

Choice B rationale:

Using the facility computer to document patient care is appropriate and not a violation of HIPAA policy, assuming the nurse is following proper security protocols.

Choice C rationale:

Looking at a neighbor's chart to add them to a prayer list at church is a clear violation of HIPAA policy. This action breaches patient confidentiality and compromises their privacy, which is essential under HIPAA regulations.

Choice D rationale:

Failing to log off the computer charting system after documenting patient care is also a violation of HIPAA policy. This can lead to unauthorized access and potential misuse of patient information, putting patient privacy at risk.

Choice E rationale:

Discussing a patient with a coworker in a public place like an elevator violates HIPAA policy. Even though the conversation is with a colleague, it is essential to protect patient information in all circumstances to maintain confidentiality and trust.

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Which intervention would be appropriate for a client with shortness of breath?

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