A nurse in a critical care unit is caring for a client who is postoperative following a right pneumonectomy. After extubation from the ventilator, in which of the following positions should the client be placed?
Prone
SemiFowler's
Sims
On the nonoperative side
The Correct Answer is B
The correct answer is: d. On the nonoperative side
Choice A: Prone
Reason: Placing a patient in the prone position (lying face down) after a pneumonectomy is generally not recommended. This position can compromise respiratory function by restricting chest expansion and increasing the risk of respiratory complications. Additionally, it can place undue pressure on the surgical site, potentially leading to complications such as impaired wound healing or increased pain.
Choice B: Semi-Fowler’s
Reason: The Semi-Fowler’s position (head of the bed elevated to 30-45 degrees) is often used to promote lung expansion and reduce the risk of aspiration. While it can be beneficial for general postoperative care, it is not the optimal position for a patient who has undergone a pneumonectomy. This position does not specifically address the need to prevent fluid accumulation in the remaining lung.
Choice C: Sims
Reason: The Sims position (lying on the side with one leg bent) is typically used for procedures such as enemas or to facilitate drainage of oral secretions. It is not suitable for a postoperative pneumonectomy patient because it does not provide the necessary support to the remaining lung and can increase the risk of fluid shifting to the nonoperative side.
Choice D: On the nonoperative side
Reason: Placing the patient on the nonoperative side is the correct position. This position helps to prevent fluid from accumulating in the remaining lung and reduces the risk of complications such as mediastinal shift or respiratory distress. By positioning the patient on the nonoperative side, gravity helps to keep the remaining lung expanded and functional.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D"]
Explanation
Choice A reason: This is incorrect. Weight gain is not a manifestation of pulmonary tuberculosis. In fact, weight loss is a common symptom of tuberculosis, as the infection causes the body to use more energy and reduce appetite. Weight loss can also be a result of malnutrition, dehydration, or other complications of tuberculosis.
Choice B reason: This is correct. Night sweats are a manifestation of pulmonary tuberculosis. They occur because the infection causes the body to produce more heat and sweat to fight off the bacteria. Night sweats can also be a sign of fever, which is another symptom of tuberculosis.
Choice C reason: This is correct. Low-grade fever is a manifestation of pulmonary tuberculosis. It occurs because the infection causes the body to raise its temperature to kill the bacteria. Fever can also be accompanied by chills, fatigue, or weakness.
Choice D reason: This is correct. Blood in the sputum is a manifestation of pulmonary tuberculosis. It occurs because the infection causes damage and inflammation to the lungs and the airways, which can bleed and mix with the mucus that is coughed up. Blood in the sputum can also be a sign of a serious complication, such as a ruptured blood vessel or a lung abscess.
Choice E reason: This is incorrect. Flushed cheeks are not a manifestation of pulmonary tuberculosis. They can be caused by various factors, such as embarrassment, exercise, alcohol, or hot weather. Flushed cheeks are not related to the infection or the inflammation of the lungs.
Correct Answer is A
Explanation
Choice A reason: Rinse the mouth after administration. This answer is correct because rinsing the mouth after using inhaled beclomethasone can help prevent oral candidiasis, a fungal infection that can cause soreness, white patches, and bleeding in the mouth.
Choice B reason: Check the pulse after medication administration. This answer is incorrect because checking the pulse after using inhaled beclomethasone is not necessary, as this medication does not affect the heart rate or blood pressure. Inhaled beclomethasone is a corticosteroid that reduces inflammation and swelling in the airways.
Choice C reason: Limit caffeine intake. This answer is incorrect because limiting caffeine intake is not related to the use of inhaled beclomethasone, but rather to the management of asthma symptoms. Caffeine can act as a bronchodilator and improve lung function, but it can also cause nervousness, insomnia, and palpitations in some people.
Choice D reason: Take the medication with meals. This answer is incorrect because taking the medication with meals is not relevant to the use of inhaled beclomethasone, as this medication is not taken orally but by inhalation. Inhaled beclomethasone is delivered directly to the lungs, where it exerts its anti-inflammatory effect.
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