A nurse is assisting in the plan of care for a client showing signs of pneumonia. Which of the following nursing actions should be included?
Obtain a sputum culture.
Cough and deep breathe every 6 hours.
Encourage fluid intake of 1500 mL/day.
Position the client prone.
The Correct Answer is A
A. Obtain a sputum culture: Obtaining a sputum culture helps identify the causative organism of pneumonia, which guides appropriate antibiotic therapy.
B. Cough and deep breathe every 6 hours: While coughing and deep breathing exercises are important for preventing complications such as atelectasis, they are not specific to pneumonia treatment and may not be appropriate for all patients with pneumonia.
C. Encourage fluid intake of 1500 mL/day: Adequate fluid intake is generally recommended for overall health but is not a specific intervention for pneumonia treatment.
D. Position the client prone: Positioning the client prone is not a standard intervention for pneumonia treatment. Depending on the severity and type of pneumonia, the client's positioning may vary, but prone positioning is not routinely recommended.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. When the patient will be resting for at least an hour: There is no specific requirement for the patient to rest after applying ointment to an inflamed skin rash.
B. In the evening before bed: While applying ointment before bed may be convenient for some patients, it may not be the best time for all patients, especially if the rash requires more frequent application.
C. In the morning before the patient dresses: Applying ointment in the morning may be appropriate, but it depends on the specific needs of the patient and the frequency of application recommended by the healthcare provider.
D. After the patient bathes: Applying ointment after the patient bathes can help ensure that the skin is clean and dry, maximizing the effectiveness of the ointment. Additionally, bathing can
help remove any debris or irritants from the skin, preparing it for the application of the ointment.
Correct Answer is A
Explanation
A. Signs of infection: Older adults may have compromised immune systems and are more susceptible to infections. During dressing changes, the nurse should assess for signs of infection such as increased redness, swelling, warmth, drainage, or foul odor, which could indicate an infection at the wound site.
B. Skin color changes: While changes in skin color can be indicative of various skin conditions or circulation problems, assessing for signs of infection is more pertinent during dressing changes to prevent and manage complications.
C. Decreased pain levels: Older adults may have altered pain perception due to age-related changes or comorbidities. However, assessing for signs of infection takes priority during dressing changes to ensure timely intervention if infection is present.
D. Changes in blood pressure: Changes in blood pressure may be relevant in certain clinical contexts but are not specifically related to performing dressing changes in older clients.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.