A nurse is caring for an adolescent client who has cystic fibrosis.
Which of the following actions should the nurse instruct the client to take prior to initiating postural drainage?
Eat a meal.
Take pancrelipase.
Use an albuterol inhaler.
Complete oral hygiene.
The Correct Answer is C
The correct answer is c. Use an albuterol inhaler.
Choice A reason: Eating a meal before postural drainage is not recommended because it can cause discomfort, nausea, or vomiting due to the positions required for the procedure.
Choice B reason: Taking pancrelipase is important for aiding digestion in cystic fibrosis patients, but it is not specifically related to the preparation for postural drainage.
Choice C reason: Bronchodilators like albuterol are used before airway clearance techniques to open the airways, making it easier to clear mucus during postural drainage.
Choice D reason: While maintaining oral hygiene is important for overall health, it is not a preparation step for postural drainage.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
Keeping an abduction pillow between the client's legs is a preventive measure to avoid dislocation of the hip prosthesis. This positioning helps maintain the correct alignment of the hip joint, reducing the risk of dislocation. Abduction pillows are commonly used postoperatively after total hip arthroplasty to support proper hip positioning while the patient is in bed.
Choice B rationale:
Elevating the client's affected leg on a pillow when in bed is not recommended after total hip arthroplasty. This position could lead to hip adduction, increasing the risk of prosthesis dislocation. Maintaining abduction (spreading the legs apart) is the key to preventing dislocation, and elevation should be avoided to maintain proper alignment.
Choice C rationale:
Positioning the client's knees slightly higher than the hips when up in a chair is not an appropriate preventive measure for prosthesis dislocation. Proper alignment is crucial, and the client should avoid sitting in low chairs or on low surfaces that could cause the hips to be lower than the knees, potentially leading to dislocation.
Choice D rationale:
Raising the head of the client's bed to a high-Fowler's position is unrelated to preventing prosthesis dislocation. Fowler's position refers to elevating the head of the bed to assist with breathing and facilitate patient comfort. While this position might be suitable for certain respiratory conditions, it has no direct impact on the stability of a hip prosthesis.
Correct Answer is C
Explanation
Choice A rationale:
Recording the client's progress in the nurses' notes is important for documentation but does not directly promote communication among staff caring for the client. It is essential for the continuity of care and legal documentation, but it does not facilitate active communication between team members.
Choice B rationale:
Posting swallowing precautions at the head of the client's bed is essential for the client's safety, especially considering the risk of aspiration following a stroke. While it ensures the staff is aware of the precautions, it does not directly promote communication among the staff members.
Choice C rationale:
Having interdisciplinary team meetings for the client on a regular basis is the best choice as it promotes communication among the staff caring for the client. Interdisciplinary team meetings allow healthcare professionals from various disciplines, such as nurses, therapists, and doctors, to collaborate, share information, and discuss the best approach to care for the client. This approach ensures comprehensive and coordinated care, addressing both the client's medical and communication needs.
Choice D rationale:
Noting changes in the treatment plan in the client's medical record is crucial for documentation and continuity of care but does not actively promote real-time communication among the staff members. While it is essential for keeping the medical record updated, it does not facilitate immediate communication and collaboration between healthcare professionals.
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