A nurse is caring for a client who is experiencing respiratory distress. Which of the following positions should the nurse assist the client into?

Trendelenburg

Tripod

Supine

Low-Fowler's Position

Answer and Explanation

The Correct Answer is B

A) Trendelenburg. This position involves tilting the patient with the head lower than the body and can worsen respiratory distress.
B) Tripod. The tripod position maximizes lung expansion by allowing the diaphragm to move freely, improving oxygenation.
C) Supine. The supine position can impair lung expansion and worsen respiratory distress.
D) Low-Fowler's Position. This position may provide minimal respiratory relief but is not as effective as the tripod position.

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Correct Answer is A

Explanation

A. Start slowly and increase volume over several sessions: Gradually increasing lung volume improves compliance and helps clients build confidence with the device.
B. Be much more vigorous in increasing increments: Rapid or forceful attempts can cause hyperventilation or dizziness and are not recommended.
C. Do regular deep-breathing exercises instead: Deep breathing can be helpful but does not replace the targeted lung expansion benefits of the incentive spirometer.
D. Use another device because this one might be faulty: Device failure is rare; user education is usually more effective.

A. examining the character of the sputum B. monitoring the rate of respirations. C. auscultating the breath sounds D. determining the last time the patient was suctioned

Correct Answer is C

Explanation

A. Examining the character of the sputum: While monitoring secretions is important, it does not necessarily indicate the need for immediate suctioning.
B. Monitoring the rate of respirations: An increased respiratory rate can indicate distress but is not a definitive cue for suctioning.
C. Auscultating the breath sounds: This helps identify the presence of secretions or airway obstruction and is a primary indicator for suctioning.
D. Determining the last time the patient was suctioned: Suctioning should be based on clinical need rather than a routine schedule.

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A nurse is caring for a client who is experiencing respiratory distress. Which of the following positions should the nurse assist the client into?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reinforcing teaching with a client who is having difficulty using an incentive spirometer. Which of the following instructions should the nurse include in the teaching?

Correct Answer is A

Explanation

A nurse caring for a patient with a tracheostomy should determine whether the patient needs suctioning by:

Correct Answer is C

Explanation

A nurse in a long-term care facility sees a client who is choking. Which of the following data should the nurse identify as requiring an abdominal thrust?

The nurse loosens mucus plugs by using percussion on a patient over the area of the:

A patient requires a precise concentration of 40% oxygen. Which of the following devices would best allow for this?

Which of the following is not considered an adventitious lung sound upon auscultation:

A nurse is preparing to suction the airway of a client who has a tracheostomy. Identify the sequence of actions the nurse should take after performing hand hygiene. (Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.)

A nurse is collecting data from a client who has a respiratory disorder and displays manifestations of hypoxia. Which of the following findings should the nurse expect?

A nurse is attending a social gathering when another guest suddenly coughs weakly once, grasps her throat with her hands, and cannot talk. Which of the following actions should the nurse take?

The nurse recognizes that, immediately before a tracheostomy cuff deflation, the patient should: