Which of the following activities related to respiratory health is an example of tertiary health promotion and illness prevention?

Administering a nebulized bronchodilator to a client who is short of breath.

Teaching a client that "light cigarettes do not prevent lung disease.

Advocating politically for more explicit warning labels on cigarette packages.

Assisting with lung function testing of a client to help determine a diagnosis.

Answer and Explanation

The Correct Answer is A

Choice A rationale:
Tertiary health promotion and illness prevention focus on managing existing health conditions and preventing complications. Administering a nebulized bronchodilator to a client who is short of breath directly addresses an existing respiratory problem, aiming to relieve symptoms and prevent further respiratory distress. This intervention falls under tertiary prevention because it targets a client already experiencing respiratory symptoms.
Key points:
Bronchodilators open constricted airways, easing airflow and breathing.
Nebulizers deliver medication directly to the lungs, providing rapid relief.
Shortness of breath is a common symptom of respiratory conditions like asthma and COPD.
Prompt treatment of respiratory symptoms can prevent worsening of the condition and potential complications.
Choice B rationale:
Teaching a client about the risks of light cigarettes is an example of primary prevention. It aims to prevent lung disease before it develops by educating individuals about the harms of smoking.
Choice C rationale:
Advocating for more explicit warning labels on cigarette packages is a form of secondary prevention. It targets at-risk populations (smokers) to encourage behavior change and reduce smoking rates, ultimately lowering the incidence of lung disease.
Choice D rationale:
Assisting with lung function testing is a diagnostic procedure, not a tertiary prevention intervention. It helps to identify respiratory problems but doesn't directly manage or prevent them.

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Correct Answer is C

Explanation

Choice A rationale:
Circular turns involve wrapping the bandage around the limb in a continuous circle, with each layer overlapping the previous one. While this technique is effective for securing dressings on cylindrical body parts like the arm or thigh, it's not ideal for joints like the ankle. Circular turns can constrict movement and potentially impair circulation, especially if applied too tightly. Additionally, they don't provide adequate compression for wounds that require it.
Choice B rationale:
Figure-of-eight turns create a cross-over pattern around the joint, resembling the number 8. This technique offers better flexibility and movement compared to circular turns, but it's still not the most appropriate for the ankle. The cross-over pattern can create uneven pressure points and potentially lead to discomfort or even skin irritation. Moreover, it might not provide sufficient compression for wound management.
Choice C rationale:
Spiral turns involve wrapping the bandage diagonally, ascending or descending the limb, with each layer overlapping the previous one by about half its width. This technique is considered the most suitable for bandaging joints like the ankle for several reasons:
Conforms to Joint Contours: Spiral turns naturally mold to the shape of the ankle, providing even pressure distribution and avoiding constriction points. This ensures comfort and maintains proper blood flow.
Allows for Movement: The diagonal pattern accommodates the natural flexion and extension of the ankle joint, allowing for greater mobility without compromising bandage integrity.
Provides Effective Compression: Spiral turns can be applied with varying degrees of compression to suit the needs of the wound and surrounding tissue. This can help control bleeding, reduce swelling, and promote healing.
Easy to Apply and Adjust: Spiral turns are relatively straightforward to apply and can be easily adjusted if needed, making them adaptable to different wound sizes and patient needs.
Choice D rationale:
Recurrent bandaging involves wrapping the bandage back and forth over the same area multiple times, creating a thicker layer. This technique is primarily used for stumps or areas requiring significant padding and absorption. It's not typically used for bandaging joints like the ankle, as it can create excessive bulk and potentially restrict movement.

A. A female client, 86 years of age, who is bed-bound B. A male client, 75 years of age, who uses a cane C. A female client, 92 years of age, who uses a walker D. A male client, 83 years of age, who is mobile

Correct Answer is A

Explanation

Choice A rationale:
Immobility: A bed-bound client is at the highest risk for pressure ulcer development due to prolonged pressure on bony prominences. The lack of movement prevents adequate blood flow to the tissues, leading to ischemia and tissue breakdown.
Age: Older adults have thinner, more fragile skin that is more susceptible to injury. They also have decreased subcutaneous fat, which provides less cushioning for bony prominences.
Nutritional status: Malnutrition is a significant risk factor for pressure ulcers, as it impairs wound healing and tissue repair. Incontinence: Urinary and fecal incontinence can irritate the skin and increase the risk of breakdown.
Chronic medical conditions: Many chronic medical conditions, such as diabetes, peripheral vascular disease, and neurological disorders, can impair blood flow and sensation, further increasing the risk of pressure ulcers.
Choice B rationale:
Mobility: A client who uses a cane is still able to ambulate, which helps to redistribute pressure and reduce the risk of pressure ulcers.
Age: While a 75-year-old client is still considered an older adult, they are less likely to be at risk than a bed-bound client.
Choice C rationale:
Mobility: A client who uses a walker is able to ambulate, although their mobility may be limited. This still helps to reduce the risk of pressure ulcers compared to a bed-bound client.
Age: A 92-year-old client is at a higher risk due to their age, but their mobility helps to mitigate this risk. Choice D rationale:
Mobility: A mobile client is at the lowest risk for pressure ulcer development, as they are able to frequently reposition themselves and relieve pressure on bony prominences.
Age: While an 83-year-old client is still considered an older adult, their mobility significantly reduces their risk.

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Which of the following activities related to respiratory health is an example of tertiary health promotion and illness prevention?

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Naxlex Comprehensive Predictor Exams

The client has an open wound on the right ankle that the registered nurse has cleansed and dressed with gauze. The nurse now needs to apply a conforming ace bandage to keep the dressing in place. What technique will the nurse use to apply the bandage on the ankle?

Correct Answer is C

Explanation

A registered nurse working in a long-term care facility is assessing residents at risk for the development of pressure ulcers. Which one would be most at risk?

Correct Answer is A

Explanation

A registered nurse is giving a talk to a local community group on the importance of proper diet and regular exercise. This is an example of which type of health promotion?

A patient is scheduled for an elective hernia repair. The patient has been taking antibiotics for an infection and has experienced episodes of diarrhea while on the antibiotic regimen. What surgical and post-surgical risk should the registered nurse monitor based on this antibiotic use?

A client tells the registered nurse, “Every time I sneeze, I wet my pants.” What is this type of involuntary escape of urine called?

A client with urine retention due to a complete prostatic obstruction requires a urinary catheter to drain the bladder. Which type of urinary catheter is most suitable for a client with an obstructed urethra?

A nursing student is assessing a postoperative client who has developed bilateral pneumonia. The nursing plan of care includes positioning the client in the semi-Fowler’s position, elevating the head of the bed from 30 degrees to 45 degrees. What is the rationale for this position?

A registered nurse is attempting to change the method for documenting client care in a medical/surgical floor setting. What questions should be considered before planning change? (Select all that apply.)

Which techniques would the registered nurse identify as regional anesthesia to a patient undergoing surgery? (Select all that apply.)