A nurse is teaching a client who has flail chest about ways to prevent further respiratory complications. Which of the following statements indicates a need for further teaching?

"I should breathe deeply."

"I should cough frequently."

"I should avoid pain medications as much as possible."

"I should use an incentive spirometer regularly."

Answer and Explanation

The Correct Answer is C

A. "I should breathe deeply."
Deep breathing prevents atelectasis and promotes gas exchange.

B. "I should cough frequently."
Frequent coughing helps clear secretions and prevent pneumonia.

C. "I should avoid pain medications as much as possible."
This is incorrect. Adequate pain control is essential for effective breathing and coughing. Pain medications should not be avoided without cause.

D. "I should use an incentive spirometer regularly."
Incentive spirometry is essential to prevent respiratory complications.

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Correct Answer is A

Explanation

A. Troponin
Troponin is the most specific and sensitive marker for myocardial injury. Levels rise within 3–6 hours of an MI.

B. C-reactive protein
CRP indicates inflammation and is nonspecific. It is not diagnostic for acute MI.

C. Brain natriuretic peptide (BNP)
BNP is used to evaluate heart failure, not primarily to diagnose MI.

D. Creatinine kinase (CK)
CK is a general marker of muscle injury; CK-MB is more specific for cardiac damage but is less accurate than troponin.

A. Apply ice packs to affected leg. B. Massage the client's affected leg twice a day. C. Have the client ambulate prior to applying anti-embolic stockings. D. Keep the client's affected leg elevated while in bed.

Correct Answer is D

Explanation

A. Apply ice packs to affected leg.
Cold therapy is not appropriate for DVT; it can worsen vasoconstriction.

B. Massage the affected leg twice a day.
Contraindicated. Massage can dislodge the clot and cause pulmonary embolism.

C. Have the client ambulate before applying anti-embolic stockings.
Stockings should be applied before ambulation to reduce risk of embolism.

D. Keep the affected leg elevated while in bed.
Promotes venous return, reduces swelling, and is appropriate for DVT management.

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A nurse is teaching a client who has flail chest about ways to prevent further respiratory complications. Which of the following statements indicates a need for further teaching?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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