A nurse is caring for a client diagnosed with pneumonia who has labored breathing and copious tracheobronchial secretions.

What priority action should the nurse encourage with the client?

Limit oral fluids to minimize labored breathing.

Lie in a low Fowler’s position to promote lung expansion.

Perform hourly incentive spirometry to inflate lungs and mobilize secretions.

Perform pursed lip breathing to expel trapped carbon dioxide from the alveoli.

Answer and Explanation

The Correct Answer is C

Choice A rationale
Limiting oral fluids is not the best action for a client with pneumonia and copious tracheobronchial secretions. Adequate hydration can actually help thin and loosen pulmonary secretions, making them easier to expel.
Choice B rationale
While lying in a low Fowler’s position can aid in lung expansion, it is not the priority action in this case. The client has copious tracheobronchial secretions, and the most effective way to mobilize these secretions is through incentive spirometry.
Choice C rationale
Performing hourly incentive spirometry can help inflate the lungs and mobilize secretions, which is particularly beneficial for a client with pneumonia who has copious tracheobronchial secretions. This is the priority action as it directly addresses the client’s issue of labored breathing due to excessive secretions.
Choice D rationale
Pursed lip breathing is a technique used primarily to slow the pace of breathing and can help maintain open airways longer. However, it is not the most effective method for mobilizing tracheobronchial secretions.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is D

Explanation

Choice A rationale
Cherry jello is not a part of a full-liquid diet. While it is soft and easy to swallow, it does not provide the necessary nutrients that a patient recovering from surgery for laryngeal cancer would need.
Choice B rationale
Clear broth soup is part of a clear liquid diet, not a full liquid diet. A full liquid diet includes foods that are liquid at room temperature or melt at body temperature.
Choice C rationale
Chicken noodle soup is not suitable for a full-liquid diet. The noodles and chicken pieces could pose a swallowing risk for a patient recovering from surgery for laryngeal cancer.
Choice D rationale
Cream of potato soup is a suitable choice for a full-liquid diet. It is smooth and easy to swallow, and it provides necessary nutrients.

A. A never event. B. A near miss. C. An adverse event. D. A sentinel event.

Correct Answer is C

Explanation

Choice A rationale
A never event refers to a particularly shocking medical error (such as wrong-site surgery) that should never occur. A surgical site infection, while unfortunate, does not fall into this category.
Choice B rationale
A near miss refers to an event that could have had adverse consequences but did not, either by chance or timely intervention. In this case, the client did experience an adverse consequence (the infection), so this term does not apply.
Choice C rationale
An adverse event is an injury caused by medical management rather than the underlying disease. In this case, the surgical site infection that developed after the knee replacement surgery can be considered an adverse event.
Choice D rationale
A sentinel event is a specific type of unexpected occurrence involving death or serious physical or psychological injury. While serious, a surgical site infection requiring prolonged antibiotic therapy and wound care does not typically fall into this category.

View Question and Answer

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

A nurse is caring for a client diagnosed with pneumonia who has labored breathing and copious tracheobronchial secretions. What priority action should the nurse encourage with the client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is educating a client after surgery for laryngeal cancer about a full liquid diet. What selection made by a client indicates to a nurse that the teaching was effective?

Correct Answer is D

Explanation

A 65-year-old client with a history of diabetes mellitus was admitted to the hospital for a scheduled knee replacement surgery. During the postoperative period, the client developed a surgical site infection that required prolonged antibiotic therapy and wound care. This event is categorized as:

Correct Answer is C

Explanation

An employee asks the occupational health nurse about measures to prevent inhalation exposure of job-related substances. Which of the following explanations should the nurse include?

A patient diagnosed with lung carcinoma is scheduled for a left pneumonectomy. Which nursing intervention should be prioritized in the immediate postoperative period?

A nurse is caring for a patient who is tearful while refusing care and medications. Which of the following is the most appropriate response by the nurse?

A nurse is preparing to administer cefaclor 500 mg PO every 12 hours. If the available cefaclor oral suspension is 250 mg/5 mL, how many mL should the nurse administer per dose?

A nurse instructor is teaching nursing students about safety, quality, and patient-centered care. What recommendations should the students recognize that promote safe, quality, patient-centered care? Select all that apply.

A nurse is preparing to discharge a patient who is post-operative following a laryngectomy. The nurse should recognize which of the following discharge teaching as the highest priority?

In the context of developing a care plan for a patient on a ventilator to prevent ventilator-associated pneumonia, which interventions should be included? Select all that apply.

A nurse is caring for a client newly diagnosed with active tuberculosis (TB) and prescribed triple antibiotic therapy. The nurse should recognize that which clinical sign indicates inadequate drug therapy after 2 months of treatment?

A nurse is caring for a client diagnosed with pneumonia who has labored breathing and copious tracheobronchial secretions.

What priority action should the nurse encourage with the client?