A nurse is caring for a client who will be placed on strict bed rest after surgery. The nurse should educate the client on the use of an incentive spirometer. The use of an incentive spirometer would prevent which postoperative complication?

Urinary tract infection

Deep vein thrombosis

Constipation

Atelectasis

Answer and Explanation

The Correct Answer is D

Choice A Reason:

Urinary tract infections (UTIs) are typically caused by bacteria entering the urinary tract. While strict bed rest can increase the risk of UTIs due to factors like catheter use and reduced mobility, the use of an incentive spirometer does not directly prevent UTIs. Instead, preventing UTIs involves maintaining good hygiene, ensuring adequate fluid intake, and, if necessary, using catheters properly.

Choice B Reason:

Deep vein thrombosis (DVT) is a condition where blood clots form in the deep veins, usually in the legs. This can occur due to prolonged immobility, such as strict bed rest after surgery. Preventing DVT involves measures like using compression stockings, administering anticoagulant medications, and encouraging leg exercises. An incentive spirometer, which is used to improve lung function, does not directly prevent DVT.

Choice C Reason:

Constipation is a common issue for patients on bed rest due to reduced physical activity and changes in diet. Preventing constipation involves ensuring adequate hydration, providing a high-fiber diet, and encouraging as much physical activity as possible. The use of an incentive spirometer, which focuses on respiratory function, does not directly address constipation.

Choice D Reason:

Atelectasis is a condition where the alveoli in the lungs collapse, leading to reduced or absent breath sounds in the affected areas. This is a common postoperative complication, especially in patients on strict bed rest, due to shallow breathing and reduced lung expansion. The use of an incentive spirometer encourages deep breathing and helps to keep the alveoli open, thereby preventing atelectasis. This is why the incentive spirometer is an essential tool for postoperative respiratory care.

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Correct Answer is C

Explanation

Advance directives are legal documents that allow individuals to outline their preferences for medical treatment in case they become unable to communicate their decisions. These documents typically include a living will and a durable power of attorney for healthcare. The living will specifies the types of medical treatment a person wishes to receive or avoid, while the durable power of attorney for healthcare designates a trusted individual to make healthcare decisions on their behalf.

Choice A Reason:

“I will get my regular doctor to approve my plan before I hand it in to the hospital.”

This statement indicates a misunderstanding of the purpose of advance directives. While it is important to discuss your advance directives with your healthcare provider, the primary purpose of these documents is to communicate your wishes regarding medical treatment, not to seek approval from your doctor. The advance directive is a personal document that reflects your values and preferences for medical care.

Choice B Reason:

“I know they won’t go ahead with the surgery unless I prepare these forms.”

This statement also reflects a misunderstanding. While having advance directives in place is highly recommended, it is not typically a prerequisite for undergoing surgery. Advance directives are important for ensuring that your medical wishes are respected, but they are not mandatory for surgical procedures. The focus should be on making sure your wishes are known and documented, rather than on the necessity of the forms for surgery.

Choice C Reason:

“I plan to write that I do not want them to keep me on a breathing machine.”

This statement correctly reflects the purpose of an advance directive. It shows that the patient understands that they can specify their preferences for medical treatment, such as whether or not they want to be kept on a breathing machine. This type of instruction is a common component of a living will, which is part of an advance directive. It ensures that healthcare providers are aware of the patient’s wishes regarding life-sustaining treatments.

Choice D Reason:

“I would rather have my brother make decisions for me, but I know he has to be my wife.”

This statement is incorrect and confusing. It seems to mix up the roles of different individuals. In an advance directive, you can designate a healthcare proxy or durable power of attorney for healthcare, who can be any trusted person, not necessarily a spouse. The statement also contains a factual error, as it implies that the brother must be the patient’s wife, which is not possible. The correct understanding is that you can choose any trusted individual to make healthcare decisions on your behalf.

A. Gastrocnemius B. Dorsogluteal C. Vastus lateralis D. Ventrogluteal

Correct Answer is C

Explanation

Choice A Reason:

The gastrocnemius muscle, located in the calf, is not a recommended site for intramuscular injections in newborns. This muscle is not typically used due to its small size and the difficulty in accessing it safely for an injection.

Choice B Reason:

The dorsogluteal muscle, located in the buttocks, is also not recommended for newborns. This site is avoided because of the risk of damaging the sciatic nerve and the relatively thick layer of subcutaneous fat, which can interfere with the absorption of the medication.

Choice C Reason:

The vastus lateralis muscle, located in the thigh, is the preferred site for intramuscular injections in newborns. This muscle is well-developed at birth and provides a large, easily accessible area for injections. It is also away from major blood vessels and nerves, making it a safe and effective site for administering medications like vitamin K.

Choice D Reason:

The ventrogluteal muscle, located on the side of the hip, is another site used for intramuscular injections, but it is not typically recommended for newborns. This site is more commonly used in older children and adults due to its deeper location and the need for precise anatomical knowledge to avoid complications.

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A nurse is caring for a client who will be placed on strict bed rest after surgery. The nurse should educate the client on the use of an incentive spirometer. The use of an incentive spirometer would prevent which postoperative complication?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is giving preoperative instructions to a patient scheduled for surgery. The patient tells the nurse, “I will prepare my advance directives before I come to the hospital.” Which statement shows the client understands advance directives?

Correct Answer is C

Explanation

A nurse is preparing to administer vitamin K by IM injection to a newborn. The nurse should administer the medication into which muscle?

Correct Answer is C

Explanation

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