The nurse is developing the plan of care for a client with pneumonia and includes the nursing problem of Ineffective airway clearance related to thick pulmonary secretions. Which intervention is most important for the nurse to include in the client's plan of care?

Increase fluid intake to 3,000 mL/daily.

Provide frequent rest periods.

Administer O2 at 5 L/minute per nasal cannula.

Maintain the client in a semi-Fowler's position.

Answer and Explanation

The Correct Answer is A

A. Increasing fluid intake helps thin pulmonary secretions, making them easier to expectorate and is most directly related to clearing the airway.
B. Providing frequent rest periods is important but does not directly clear the airway.

C. Administering O2 addresses hypoxia but does not clear secretions.

D. Semi-Fowler's position helps with breathing but does not specifically address thick secretions.

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Correct Answer is ["1.4"]

Explanation

To calculate the dosage of lorazepam for the client, first determine the total micrograms required by multiplying the client's weight in kilograms by the prescribed amount per kilogram. For a client weighing 65 kg prescribed 44 mcg/kg, the total dosage would be 65 kg x 44 mcg/kg, which equals 2860 mcg. Since the medication is available in a concentration of 2 mg/ml, convert the total dosage from micrograms to milligrams by dividing by 1000 (because there are 1000 micrograms in a milligram). This results in 2.86 mg. Finally, to find out how many milliliters to administer, divide the total milligrams needed by the concentration of the vial, which is 2 mg/ml. Therefore, 2.86 mg / 2 mg/ml equals 1.43 ml. When rounding to the nearest tenth, the nurse should administer 1.4 ml of lorazepam.

A. Use background music to promote relaxation. B. Turn on overhead lights while giving instructions. C. Stand behind the client to avoid intimidation. D. Provide handouts written at a 12th grade reading level. E. Provide handouts written at a 12th grade reading level.

Correct Answer is D

Explanation

A. Background music may be distracting rather than helpful during teaching.

B. Adequate lighting is crucial for older adults to clearly see and read instructional materials. However, overhead lights may be distracting and disorienting for an older adult.
C. Standing behind the client might actually increase feelings of intimidation or discomfort. It's better to face the client to facilitate communication.
D. Providing handouts written at a 12th grade reading level ensures that the information is accessible and understandable for the majority of adults.

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The nurse is developing the plan of care for a client with pneumonia and includes the nursing problem of Ineffective airway clearance related to thick pulmonary secretions. Which intervention is most important for the nurse to include in the client's plan of care?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is ["1.4"]

Explanation

An older adult client presents to the emergency department with abdominal pain due to constipation. The nurse is providing a list of high-fiber foods to the client that the healthcare provider has recommended. Which action should the nurse implement when reviewing the list of foods?

Correct Answer is D

Explanation

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