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 D

Explanation

A. Gowns and gloves are not required for TB precautions; a mask is necessary to protect against airborne transmission.
B. Standard protocols for personal protective equipment (PPE) should be followed, but they do not specifically address the need for specialized precautions in TB care.
C. Clients with TB should not be placed in a room with others, even those requiring droplet precautions, due to the risk of airborne transmission.
D. A private room with a special ventilation system, such as negative pressure, is essential for isolating clients with active TB to prevent airborne transmission.

A. Airway obstruction B. Infection C. Paralytic ileus D. Fluid imbalance

Correct Answer is A

Explanation

A. Airway obstruction is the priority because burns to the head, neck, and chest can compromise the airway due to swelling, soot, and edema. Immediate assessment and intervention are critical to ensure the airway remains patent and to prevent respiratory distress.

B. While infection is a significant risk in burn patients, addressing airway concerns takes precedence to prevent immediate life-threatening complications.

C. Paralytic ileus is a concern in burn patients but is less immediate compared to the risk of airway obstruction.

D. Fluid imbalance is crucial in burn management, but ensuring a clear airway is the immediate priority to prevent severe complications such as asphyxia.

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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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A nurse is preparing for the admission of a client who has suspected active tuberculosis. Which of the following precautions should the nurse plan to implement to safely care for this client?

Correct Answer is D

Explanation

A nurse in the emergency department is caring for a client who has extensive partial and full-thickness burns of the head, neck, and chest. While planning the client's care, the nurse should identify which of the following risks as the priority for assessment and intervention?

Correct Answer is A

Explanation

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