A nurse is reinforcing teaching with a client who is preoperative following abdominal surgery about deep breathing and coughing exercises. Which of the following client statements should indicate to the nurse an understanding of the instructions?

"I start to use the incentive spirometer when I can get out of bed."

"I breathe deeply and cough every 4 hours."

"I splint my incision with a pillow to cough."

"I lie flat in bed to cough and deep breathe."

Answer and Explanation

The Correct Answer is C

Choice A reason: Using the incentive spirometer is important, but it is not specifically related to deep breathing and coughing exercises.

Choice B reason: Breathing deeply and coughing every 4 hours is part of postoperative care, but it does not indicate understanding of the technique to protect the incision.

Choice C reason: Splinting the incision with a pillow while coughing is a recommended technique to support the incision and reduce pain during coughing, indicating an understanding of the instructions.

Choice D reason: Lying flat is not recommended for deep breathing and coughing exercises as it can inhibit lung expansion and is not conducive to effective coughing.

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Correct Answer is A

Explanation

Choice A reason: This response is calming and supportive. It addresses Mr. L's immediate distress by providing reassurance and a directive that can help him manage his panic, which is essential in a situation where a patient is experiencing extreme anxiety.

Choice B reason: While taking vital signs is an important step, it should not be the first response. The priority is to address the patient's acute distress and provide reassurance.

Choice C reason: This response minimizes the patient's feelings and does not address his immediate fear or offer any comfort or support.

Choice D reason: Asking why he thinks he's having a heart attack could increase his anxiety. It's important to first calm the patient before attempting to rationalize the situation.

A. Provide ordered enteral nutrition. B. Monitor ordered IV fluids. C. Obtain blood cultures before antibiotics. D. Give broad-spectrum antibiotics within one hour of septic shock diagnosis.

Correct Answer is D

Explanation

Choice A reason: While nutrition is important, it is not the immediate priority in the management of septic shock.

Choice B reason: Monitoring IV fluids is important, but the initial priority is to treat the infection causing the septic shock.

Choice C reason: Obtaining blood cultures is important, but it should not delay the administration of antibiotics.

Choice D reason: The administration of broad-spectrum antibiotics within one hour of diagnosing septic shock is critical to improve outcomes and is considered a priority action.

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A nurse is reinforcing teaching with a client who is preoperative following abdominal surgery about deep breathing and coughing exercises. Which of the following client statements should indicate to the nurse an understanding of the instructions?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Mr. L, who has a severe fear of needles, is hospitalized on your medical unit. The laboratory technician enters to draw blood for the routine CBC, and Mr. L begins to cry out, "Get away from me! I can't breathe! I'm having a heart attack!" What should be your first response to Mr. L?

Correct Answer is A

Explanation

Which of these would the nurse implement as the priority action for the patient with newly diagnosed septic shock?

Correct Answer is D

Explanation

A general goal for a patient with a Personality Disorder is:

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