A nurse in a long-term care facility is assisting a client with eating during meal time and recognizes another client indicating he is choking. Which of the following situations requires the nurse to perform the Heimlich maneuver?
The client is coughing only.
The client is not making any sounds.
The client is able to whisper.
The client has a high-pitched inspiratory stridor.
The Correct Answer is B
A. A client who is coughing only is still able to clear the airway by themselves.
B. Inability to make any sounds indicates a complete airway obstruction, requiring the Heimlich maneuver.
C. A client who can whisper has a partial airway obstruction and should be encouraged to continue coughing.
D. A high-pitched inspiratory stridor indicates a partial obstruction, not requiring the Heimlich maneuver but close monitoring.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Rationale:
A. Negligence involves failing to provide care that a reasonably prudent nurse would provide, such as leaving a shift early without proper handoff or notification, which could compromise patient safety.
B. Battery involves unlawful touching of a patient without consent, which is not applicable in this situation.
C. Slander involves making false spoken statements that harm a person's reputation, which is not applicable in this situation.
D. Libel involves making false written statements that harm a person's reputation, which is not applicable in this situation.
Correct Answer is B
Explanation
A. Emphasizing the significance of the information may not address the cultural behavior of avoiding direct eye contact.
B. Continuing with the discussion respects the client's cultural behavior, as some cultures view direct eye contact as disrespectful.
C. Stopping the instructions to see what is on the floor may misunderstand the client's cultural behavior.
D. Moving closer for eye contact may make the client uncomfortable if their culture views direct eye contact as inappropriate.
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