A nurse is developing a plan of care for a client who is postoperative. Which of the following interventions should the nurse include in the plan to prevent pulmonary complications?

Administer an expectorant

Perform range-of-motion exercises

Place suction equipment at the bedside

Encourage the use of an incentive spirometer

Answer and Explanation

The Correct Answer is D

A. Administering an expectorant is not primarily aimed at preventing pulmonary complications but rather at helping to clear mucus. While this can be part of respiratory care, it does not address the prevention of complications like atelectasis or pneumonia.

B. Performing range-of-motion exercises is important for overall mobility and prevention of deep vein thrombosis but does not specifically address the prevention of pulmonary complications.

C. Placing suction equipment at the bedside is useful for managing secretions but does not directly prevent pulmonary complications. It is a reactive measure rather than preventive.

D. Encouraging the use of an incentive spirometer is an effective method to prevent pulmonary complications such as atelectasis and pneumonia. It helps improve lung function by promoting deep breathing and expanding the alveoli.

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Correct Answer is C

Explanation

A. The client's platelet count is within the normal range (150,000-450,000/mm³), indicating no increased risk for bleeding based on this parameter.

B. Although a diet with increased protein may be beneficial for overall health and wound healing, the primary concern here is the low WBC count, which indicates an increased risk of infection.

C. The client's WBC count is significantly low (1,400/mm³, with normal being around 4,000-11,000/mm³), indicating leukopenia and an increased risk of infection, a common side effect of cisplatin and other chemotherapy agents.

D. Erythropoiesis-stimulating agents are typically used for anemia management, but the primary issue here is the low WBC count, not the RBC count or hemoglobin levels.

A. Frothy pink drainage B. Greenish-yellow drainage C. Dark amber drainage D. Coffee-ground drainage

Correct Answer is D

Explanation

A. Frothy pink drainage is more characteristic of recent or active bleeding rather than an upper gastrointestinal bleed.
B. Greenish-yellow drainage typically indicates bile or gastric secretions rather than blood.
C. Dark amber drainage might suggest older, degraded blood but is less specific to an active upper GI bleed.
D. Coffee-ground drainage is indicative of older, partially digested blood and is expected in cases of upper gastrointestinal bleeding due to the breakdown of blood in the stomach.

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A nurse is developing a plan of care for a client who is postoperative. Which of the following interventions should the nurse include in the plan to prevent pulmonary complications?

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Naxlex Comprehensive Predictor Exams

Correct Answer is C

Explanation

A nurse is caring for a client who has an active upper gastrointestinal bleed. After inserting an NG tube into the client, which of the following findings should the nurse anticipate?

Correct Answer is D

Explanation

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