Which of the following does the nurse implement to prevent postoperative respiratory complications for a patient? (Select all that apply)
Deep breathing and coughing
Incentive spirometry
Leg exercises
Early ambulation
Hand squeezes
Correct Answer : A,B,D
Choice A reason: Deep breathing and coughing exercises help clear the lungs and prevent atelectasis, a common postoperative respiratory complication.
Choice B reason: Incentive spirometry encourages patients to take deep breaths, which can help keep the lungs clear of mucus and prevent pneumonia.
Choice C reason: Leg exercises improve circulation and can help prevent blood clots, which can lead to pulmonary embolism, another serious respiratory complication.
Choice D reason: Early ambulation, or getting the patient moving as soon as possible after surgery, is crucial for preventing respiratory complications by promoting circulation and lung expansion.
Choice E reason: Hand squeezes are not directly related to preventing respiratory complications; they are more associated with preventing circulatory complications.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A: "I’m sorry if I upset you. I just wanted to make sure you’re aware of the day’s schedule."
This response may seem empathetic, but it could potentially reinforce the client's aggressive behavior. The nurse is apologizing, which might give the impression that the client's rude behavior is acceptable¹.
Choice B: "Well, if you can read it yourself, then why don’t you?"
This response is confrontational and could escalate the situation. It's important for the nurse to maintain a neutral and respectful manner.
Choice C: "You don’t have to be so rude. I’m just doing my job."
This response is defensive and could provoke further aggression from the client. It's not recommended to respond defensively to clients with borderline personality disorder¹.
Choice D: "I didn’t mean to offend you. I’ll leave the schedule here for you to review."
This is the most appropriate response. The nurse acknowledges the client's feelings without reinforcing the aggressive behavior. The nurse also respects the client's autonomy by leaving the schedule for the client to review¹.
Correct Answer is A
Explanation
Choice A reason: For a client with borderline personality disorder, the priority is to ensure safety, which includes protecting them from self-harm behavior, as they may have impulsive tendencies that can lead to self-injury.
Choice B reason: While providing strategies for redirecting violent behavior is important, it is secondary to ensuring the client's immediate safety.
Choice C reason: Exploring reasons for behavior is a therapeutic intervention that can help in the long term but is not the immediate priority.
Choice D reason: Encouraging the client to talk about their feelings is part of ongoing therapy but does not take precedence over ensuring the client's safety.
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