A client with obstructive sleep apnea (OSA ambulates in the hallway with the nurse prior to bedtime and then returns to bed. Which intervention is most important for the nurse to implement before leaving the client?
Apply the client's positive airway pressure device.
Elevate the head of the bed to a 45-degree angle.
Remove dentures or other oral appliance.
Lift and lock the side rails in place.
The Correct Answer is A
A. Applying the positive airway pressure (PAP) device is crucial for managing obstructive sleep apnea (OSA and ensuring the client receives continuous positive airway pressure during sleep to prevent airway obstruction.
B. Elevating the head of the bed may be helpful in managing OSA, but ensuring the client uses the PAP device takes precedence.
C. Removing dentures or other oral appliances may improve comfort but is not as essential as ensuring proper use of the PAP device.
D. Lifting and locking the side rails may be important for safety but is not directly related to managing OSA.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. An abdominal binder can be worn daily to reduce the protrusion: This is not an appropriate intervention for an umbilical hernia in an infant. Abdominal binders are typically used for support after abdominal surgeries or to manage hernias in adults.
B. This hernia is a normal variation that resolves without treatment: Umbilical hernias are common in infants and typically resolve on their own without intervention by around 1 to 2 years of age. Reassuring the mother about the benign nature of the hernia is appropriate.
C. The quarter should be secured with an elastic bandage wrap: Taping a quarter over the umbilicus is not a recommended treatment for an umbilical hernia and could pose a choking hazard to the infant.
D. Restrictive clothing will be adequate to help the hernia go away: Restrictive clothing is not an effective treatment for umbilical hernias in infants and could potentially cause discomfort or complications.
Correct Answer is C
Explanation
A. Notify the emergency response team of the client's seizure: While the seizure is significant, it lasted less than 1 minute and resolved spontaneously. There is no need to call an emergency response team unless complications arise or the seizure becomes prolonged.
B. Keep orienting the client to time and space until he is less confused: While supportive, this is not the priority. Postictal confusion is expected and does not usually require active reorientation until the client regains baseline status.
C. Explain the postictal state that usually follows seizures: Providing reassurance and education to the spouse about postictal symptoms (such as confusion, lethargy, and altered responsiveness) is appropriate and therapeutic. It addresses her concern while monitoring the client for further changes.
D. Ask the wife to wait outside the room until the nurse can talk with her: This action excludes the spouse unnecessarily and delays communication. Involving the family promotes trust and understanding.
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