A nurse is providing discharge teaching for a client who requires home oxygen therapy. Which of the following statements should the nurse identify as an indication that the client needs further teaching?
"I will wear synthetic clothing and woolen socks when using my oxygen.”
"I will make sure my visitors smoke outside.”
"I will be able to tell how much oxygen I'm getting by looking at the flowmeter.”
"I should call my doctor if I find it harder to concentrate.”
The Correct Answer is A
Choice A rationale:
This statement indicates a need for further teaching. Synthetic clothing and woolen socks can generate static electricity, which poses a risk around oxygen due to its flammable nature. The client should be advised to wear cotton clothing and avoid synthetic fabrics to prevent static-related accidents.
Choice B rationale:
This statement is correct. Oxygen supports combustion, so ensuring visitors don't smoke near the client is crucial. However, it does not indicate a need for further teaching.
Choice C rationale:
This statement is incorrect. The client cannot determine the oxygen flow rate by visual inspection of the flowmeter. The flow rate should be set based on the healthcare provider's instructions, and this information should have been covered in the teaching.
Choice D rationale:
This statement indicates the client understands the potential cognitive effects of oxygen therapy and when to seek medical assistance. It does not necessarily indicate a need for further teaching.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
Applying a moisture barrier ointment helps protect the skin from the effects of moisture exposure due to urinary incontinence. Prolonged exposure to urine can lead to skin breakdown, irritation, and infection. A moisture barrier ointment creates a protective barrier, reducing the risk of skin damage.
Choice B rationale:
Requesting a prescription for an indwelling urinary catheter is not typically the first intervention to prevent skin breakdown in clients with urinary incontinence. Catheters carry their own set of risks, including infection, and should be considered after other interventions have been explored.
Choice C rationale:
Repositioning the client every 8 hours is important for preventing pressure ulcers but may not be sufficient to prevent skin breakdown due to urinary incontinence. Clients with urinary incontinence should be repositioned more frequently to address the effects of moisture.
Choice D rationale:
Checking the client's skin every 8 hours is an important step, but it alone may not effectively prevent skin breakdown. Incontinence-associated dermatitis can develop quickly, so it's essential to implement protective measures like using a moisture barrier ointment.
Correct Answer is ["B","D","E"]
Explanation
Choice A rationale:
Drowsiness alone may not be a reliable indicator of pain, as it can result from various factors such as medications or the postoperative recovery process. While pain might cause drowsiness in some cases, it is not a definitive nonverbal sign of pain.
Choice B rationale:
Grimacing is a nonverbal behavior that often indicates pain or discomfort. It involves facial expressions of pain, such as frowning or wincing. Grimacing is a significant indicator that the nurse should consider in assessing the client's pain level.
Choice C rationale:
Screaming is a more overt expression of pain and discomfort. However, it is less common in a postoperative setting and might also be associated with anxiety or other emotional states. While it can indicate pain, it's not as reliable a marker as grimacing, moaning, or restlessness.
Choice D rationale:
Moaning is a nonverbal behavior that can signal pain in a postoperative client. It's an audible expression of discomfort and should be considered as a potential indication of pain.
Choice E rationale:
Restlessness can be an indication of pain as well. The client may shift positions frequently or exhibit signs of agitation in response to pain. However, restlessness can also have other causes, such as anxiety or medication effects.
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