A patient is experiencing dyspnea.
Which intervention(s) would the nurse implement for the patient? Select all that apply.

Encourage the patient to use an incentive spirometer.

Auscultate lung sounds bilaterally.

Ambulate the patient in the hall.

Position the bed in high fowlers.

Assess the pulse oximetry.

Answer and Explanation

Correct Answer : A,B,D,E

Choice A rationale:

Encourage the patient to use an incentive spirometer. Rationale: Encouraging the use of an incentive spirometer helps improve lung function and prevent respiratory complications. It promotes deep breathing and prevents atelectasis, especially in patients experiencing dyspnea.

Choice B rationale:

Auscultate lung sounds bilaterally. Rationale: Auscultating lung sounds helps the nurse assess for abnormal breath sounds, such as wheezing or crackles, which can indicate respiratory distress. This assessment is crucial in managing a patient with dyspnea.

Choice C rationale:

Ambulate the patient in the hall. Rationale: Ambulating the patient can worsen dyspnea in some cases, especially if the patient is experiencing severe respiratory distress. Therefore, this intervention may not be appropriate for a patient with dyspnea.

Choice D rationale:

Position the bed in high fowlers. Rationale: Positioning the patient in high fowlers (sitting upright with the head of the bed elevated) helps improve lung expansion and ease breathing. This position maximizes the patient's lung capacity and can provide relief from dyspnea.

Choice E rationale:

Assess the pulse oximetry. Rationale: Monitoring pulse oximetry levels is essential in assessing the patient's oxygen saturation. It helps the nurse determine if the patient is receiving adequate oxygenation, which is crucial in managing dyspnea. A normal oxygen saturation range is typically 95% to 100%.

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Correct Answer is B

No explanation

A. Extension. B. Abduction. C. Flexion. D. Adduction.

Correct Answer is C

Explanation

Choice A rationale:

Extension refers to the straightening of a joint and is the opposite of flexion. It is not the correct term for the described hand movement.

Choice B rationale:

Abduction is the movement of a body part away from the midline of the body. It does not describe the specific movement of the patient's hand toward the inner aspect of the forearm.

Choice C rationale:

Flexion is the bending of a joint, decreasing the angle between two body parts. When the nurse moves the patient's hand toward the inner aspect of the forearm, it is a flexion movement of the wrist.

Choice D rationale:

Adduction is the movement of a body part toward the midline of the body. It is not the correct term for the described hand movement.

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A patient is experiencing dyspnea.Which intervention(s) would the nurse implement for the patient? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is B

The nurse moves the patient's hand toward the inner aspect of the patient's forearm.This range of motion exercise would be documented as what of the wrist?

Correct Answer is C

Explanation

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A patient is experiencing dyspnea.
Which intervention(s) would the nurse implement for the patient? Select all that apply.