A nurse is providing education to a client who has a prescription for incentive spirometry. Which of the following instructions should the nurse include in the teaching?

"Use the incentive spirometer every 4 hours."

"Avoid coughing during and after the session."

"Remove the mouthpiece and exhale quickly."

"Place the mouthpiece in your mouth and inhale slowly."

Answer and Explanation

The Correct Answer is D

A. "Use the incentive spirometer every 4 hours.": Incentive spirometry is typically recommended every 1 to 2 hours while awake to promote lung expansion and prevent atelectasis. Less frequent use may not provide adequate lung re-expansion, especially after surgery.

B. "Avoid coughing during and after the session.": Coughing is encouraged after using an incentive spirometer to help clear secretions and prevent respiratory complications such as pneumonia. Suppressing a cough can lead to mucus retention and increased risk of infection.

C. "Remove the mouthpiece and exhale quickly.": The client should exhale normally before using the spirometer, then inhale slowly through the mouthpiece to maximize lung expansion. Rapid exhalation does not promote adequate alveolar inflation.

D. "Place the mouthpiece in your mouth and inhale slowly.": Slow, deep inhalation through the spirometer allows for maximum lung expansion, reducing the risk of atelectasis. The client should maintain a steady breath to ensure optimal lung inflation and hold it for a few seconds before exhaling.

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Correct Answer is A

Explanation

A. Purulent drainage: The presence of purulent drainage suggests a possible wound infection, which requires immediate evaluation and potential intervention by the provider. Signs of infection may include increased warmth, redness, swelling, and fever. Culturing the wound and initiating appropriate antibiotic therapy may be necessary.

B. Edema: Mild edema around the surgical site is a common postoperative finding due to localized inflammation and tissue healing. Unless accompanied by other concerning signs like excessive drainage or warmth, it is not typically a cause for alarm.

C. Ecchymotic skin: Bruising around the incision site is expected after surgery due to minor blood vessel trauma during the procedure. It usually resolves without intervention and does not necessarily indicate a complication.

D. Erythema: Some redness around the incision is normal in the early postoperative period as part of the inflammatory response to healing. However, increasing or spreading erythema, particularly with warmth and tenderness, may indicate infection and should be further evaluated.

A. Insert a urinary catheter. B. Prepare the client for an intravenous pyelogram. C. Administer IV fluids to the client. D. Initiate beta blocker therapy.

Correct Answer is C

Explanation

A. Insert a urinary catheter: While a urinary catheter may be necessary for monitoring urine output, it does not directly prevent acute kidney failure. Maintaining adequate perfusion and hydration is the primary concern in preventing kidney injury.

B. Prepare the client for an intravenous pyelogram: An intravenous pyelogram (IVP) involves contrast dye, which can be nephrotoxic and potentially worsen kidney function. It is not appropriate in a client at risk for acute kidney injury.

C. Administer IV fluids to the client: Fluid resuscitation helps maintain adequate renal perfusion and prevents hypovolemia-induced acute kidney failure. Clients with significant blood loss are at high risk for prerenal kidney injury due to decreased perfusion.

D. Initiate beta blocker therapy: Beta blockers are used for cardiovascular conditions but do not prevent acute kidney failure. In this situation, maintaining blood volume and renal perfusion is the priority.

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A nurse is providing education to a client who has a prescription for incentive spirometry. Which of the following instructions should the nurse include in the teaching?

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