A nurse is caring for a patient at risk for atelectasis.
Which independent nursing measure should the nurse prioritize to prevent the development of atelectasis?
Ambulation.
Oxygen therapy.
Incentive spirometry.
Increase oral fluid intake.
The Correct Answer is C
Choice A rationale
Ambulation is a general measure that can help improve overall lung function by promoting deep breathing, coughing, and mobilization of secretions. However, it is not the primary measure to prevent atelectasis.
Choice B rationale
Oxygen therapy is used to treat hypoxia, which can be a result of atelectasis. However, it does not directly prevent the development of atelectasis.
Choice C rationale
Incentive spirometry is a first-line measure to prevent atelectasis. It encourages deep breathing, which helps keep the alveoli inflated and can prevent them from collapsing, thus preventing atelectasis.
Choice D rationale
Increasing oral fluid intake can help to thin secretions, making them easier to mobilize. However, it is not the primary measure to prevent atelectasis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
While it’s important to reassure the patient, saying “It’s uncertain if your smoking led to the cancer” might be misleading. Smoking is a major risk factor for lung cancer, but it’s also true that not everyone who smokes gets lung cancer, and not everyone who gets lung cancer has smoked.
Choice B rationale
This response validates the patient’s feelings and opens up a dialogue about their specific fears. It allows the nurse to provide targeted education and reassurance.
Choice C rationale
Asking “Do you feel guilty because you used to smoke?” might make the patient feel more guilty or judged. It’s better to provide support and understanding.
Choice D rationale
While it’s true that fear is a normal reaction and that the healthcare team is there to support the patient, this response doesn’t address the patient’s specific concerns or feelings of guilt.
Correct Answer is C
Explanation
Choice A rationale
Written competency exams can assess theoretical knowledge and understanding of procedures, but they may not accurately reflect practical skills or performance under real-life conditions.
Choice B rationale
Insence training, while potentially beneficial for enhancing certain skills, may not be the most effective method for improving confidence and performance in response to a “code”. It lacks the realism and immediacy of a code situation.
Choice C rationale
Simulation-based mock codes provide a safe environment where staff can practice their skills, learn from their mistakes, and improve their performance without risk to patients. They can enhance confidence, competence, and performance in real code situations.
Choice D rationale
Peer-to-peer feedback sessions can provide valuable insights and foster a culture of continuous learning and improvement. However, they may not offer the same level of structured, targeted skill development and performance improvement as simulation-based mock codes.
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