A nurse is implementing a plan of care for a client who has AIDS with recurring pneumonia.

Which of the following actions should the nurse take?

Obtain a sputum culture.

Position head of bed at 10 degrees.

Cough and deep breathe every 8 hr.

Encourage fluid intake of 1500 mL/day.

Answer and Explanation

The Correct Answer is A

Choice A rationale:
Obtaining a sputum culture helps identify the causative organism and guide treatment.
Choice B rationale:
Positioning the head of bed at 10 degrees is not beneficial for pneumonia patients.
Choice C rationale:
Coughing and deep breathing every 8 hours is not frequent enough for pneumonia patients.
Choice D rationale:
Encouraging fluid intake of 1500 mL/day is not sufficient for pneumonia patients.

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Correct Answer is A

Explanation

Choice A rationale:
Increasing fluid intake can help replace cerebrospinal fluid lost during a lumbar puncture, which can alleviate a post-lumbar puncture headache.
Choice B rationale:
Elevating the head of the bed can actually worsen a post-lumbar puncture headache by increasing the loss of cerebrospinal fluid.
Choice C rationale:
While pain medication can provide temporary relief, it does not address the underlying cause of the headache.
Choice D rationale:
Darkening the room and closing the door can help reduce sensory stimulation, but it does not directly address the cause of the headache.

A. Irrigate the catheter. B. Notify the provider. C. Check the tubing for kinks. D. Adjust the rate of the bladder irrigant.

Correct Answer is C

Explanation

Choice A rationale:
Irrigating the catheter may be necessary, but it is not the first action to take.
Choice B rationale:
Notifying the provider is important, but there are actions the nurse can take first.
Choice C rationale:
Checking the tubing for kinks is the first action because it is a simple and non-invasive intervention.
Choice D rationale:
Adjusting the rate of the bladder irrigant may be necessary, but it is not the first action to take.

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A nurse is implementing a plan of care for a client who has AIDS with recurring pneumonia. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who reports a throbbing headache after a lumbar puncture. Which of the following actions is most likely to facilitate resolution of the headache?

Correct Answer is A

Explanation

A nurse is caring for a client who is 5 hr postoperative following a transurethral resection of the prostate (TURP). The nurse notes that the client's indwelling urinary catheter has not drained in the past hour. Which of the following actions should the nurse take first?

Correct Answer is C

Explanation

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A nurse is implementing a plan of care for a client who has AIDS with recurring pneumonia.

Which of the following actions should the nurse take?