A nurse is monitoring a client who is postoperative. Which of the following actions should the nurse take when collecting data about the client's respirations?
Place the client in a supine position.
Observe the movements of the client's chest wall.
Inform the client when beginning to observe his respirations.
Count the client's respirations for 15 seconds.
The Correct Answer is B
To accurately assess the client's respirations, the nurse should observe the movements of the client's chest wall. This can be done by visually inspecting the rise and fall of the chest or by placing a hand on the client's chest to feel the movements. This allows the nurse to assess the depth, rhythm, and effort of the client's breathing. I
It is important to observe the client's respirations without informing them, as this may cause the client to alter their breathing pattern consciously.
Counting the client's respirations for a full minute (rather than 15 seconds) provides a more accurate measurement.
Placing the client in a supine position may not be necessary for assessing respirations, as it is primarily focused on observing the chest movements.
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Related Questions
Correct Answer is C
Explanation
Palliative care is an approach to care that focuses on improving the quality of life for individuals with serious or life-threatening illnesses. It aims to provide relief from pain, symptoms, and stress, rather than focusing solely on curing the underlying disease. Palliative care can be provided alongside curative treatments and is not limited to clients with a specific life expectancy.
It does not involve the restriction of nutritional support but rather aims to address the overall physical, emotional, and spiritual needs of the client.
While palliative care may be provided to clients with terminal illnesses, it is not exclusive to them, as it can be initiated at any stage of a serious illness.
Correct Answer is B
Explanation
Giving the client the opportunity to participate in decision-making regarding the timing of treatments and procedures respects their autonomy and allows them to have some control over their care.
Be honest with the client about the prognosis: By providing accurate and honest information, the nurse respects the client's right to know and be involved in decision-making regarding their healthcare.
Provide privacy during client care procedures: Respecting the client's privacy during care procedures allows them to maintain a sense of dignity and control over their body.
Administer pain medication on a routine schedule: Ensuring that pain medication is provided on a routine schedule allows the client to have control over their pain management and helps maintain their comfort and quality of life
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