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 A
Explanation
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.
Correct Answer is C
Explanation
A. Providing pain medication to increase the client's tolerance of labor pains: Pain management is important throughout labor, but in the second stage, the focus shifts to pushing efforts and fetal expulsion. Pain medication may affect the client's ability to push effectively and may not be
indicated at this stage.
B. Assessing the fetal heart rate and pattern for signs of fetal distress: Fetal monitoring is essential throughout labor, including the second stage, to assess fetal well-being and detect signs of
distress. However, the specific intervention indicated for the second stage is assisting the client with pushing.
C. Assisting the client to push effectively so that expulsion of the fetus can be achieveD Correct!
In the second stage of labor, the cervix is fully dilated, and the focus is on pushing efforts to
facilitate the birth of the baby. The nurse plays a crucial role in supporting the client during this stage by providing guidance on effective pushing techniques and encouragement.
D. Monitoring effects of oxytocin administration to help achieve cervical dilation: Oxytocin administration is typically used in the first stage of labor to induce or augment contractions and facilitate cervical dilation. Monitoring its effects is important, but it is not a specific intervention for the second stage of labor, where the focus is on pushing and fetal expulsion.
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