The nurse observes an adult client perform a return demonstration of diaphragmatic breathing. The client inhales while holding the abdomen, then removes the hand to allow expansion of the abdomen during exhalation. Which action should the nurse take after observing the client’s demonstration?

Remind the client to keep light pressure on the abdomen and cough after fully exhaling.

Confirm that the breathing technique was correct but hand pressure is not necessary.

Document that the client successfully demonstrated the diaphragmatic breathing technique.

Demonstrate how to expand the abdomen while inhaling and let it relax while exhaling.

Answer and Explanation

The Correct Answer is D

Choice A reason: Keeping pressure on the abdomen and coughing is incorrect for diaphragmatic breathing, which enhances lung expansion, not airway clearance. Coughing is for post-drainage. The client’s incorrect technique (abdominal expansion on exhalation) requires correction, as this reverses mechanics, reducing ventilation efficiency in conditions like COPD.

Choice B reason: The client’s technique is incorrect, expanding the abdomen on exhalation, not inhalation, reducing diaphragmatic efficacy. Confirming it as correct is wrong, as it impairs lung expansion. Demonstrating proper technique corrects the error, ensuring effective breathing to improve oxygenation, addressing the physiological need for ventilation.

Choice C reason: Documenting success is inaccurate, as the client’s technique is reversed, expanding the abdomen on exhalation. Diaphragmatic breathing requires inhalation expansion to lower the diaphragm, increasing lung capacity. Correcting the technique via demonstration ensures proper mechanics, not documenting an ineffective method that hinders ventilation.

Choice D reason: Demonstrating proper diaphragmatic breathing corrects the client’s error of exhalation expansion. Inhaling expands the abdomen via diaphragmatic descent, increasing tidal volume; exhaling relaxes it. This optimizes ventilation, addressing the need for effective breathing in conditions requiring enhanced lung function, ensuring the client learns the correct technique.

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Correct Answer is B

Explanation

Choice A reason: Taking ibuprofen on an empty stomach increases gastrointestinal irritation, as NSAIDs inhibit prostaglandins, reducing gastric mucus protection. This risks gastritis or ulcers. Taking it with food minimizes irritation, making this instruction incorrect and potentially harmful for clients managing chronic arthritic pain with ibuprofen.

Choice B reason: Ibuprofen, an NSAID, risks gastrointestinal bleeding by inhibiting prostaglandins, weakening stomach lining protection, and impairing platelet aggregation. Symptoms like black stools or hematemesis indicate serious complications. Reporting these ensures early intervention, preventing severe outcomes like perforation or anemia, making this a critical instruction for safe use.

Choice C reason: High-intensity sunblock is relevant for photosensitizing drugs (e.g., doxycycline), not ibuprofen, which does not significantly increase photosensitivity. NSAIDs primarily affect cyclooxygenase pathways, not skin UV sensitivity. Reporting gastrointestinal bleeding is more critical, as it addresses a common, severe side effect requiring urgent attention.

Choice D reason: Ibuprofen can elevate blood pressure via sodium retention and vasoconstriction, but this is less common at standard doses. Gastrointestinal bleeding is a more frequent, severe risk, as NSAIDs disrupt gastric mucosa. Reporting bleeding symptoms takes precedence to prevent life-threatening complications, making blood pressure monitoring secondary.

A. Insertion of a small bore tube for continuous enteral feedings. B. Intravenous administration of a proton pump inhibitor. C. Total parenteral nutrition administration via a central catheter. D. Insertion of a nasogastric tube to low intermittent suction.

Correct Answer is B

Explanation

Choice A reason: Inserting a small bore tube for enteral feedings is inappropriate for acute GERD exacerbation, as feeding increases gastric volume, worsening reflux by raising pressure and acid exposure. Proton pump inhibitors (PPIs) reduce acid production, alleviating mucosal irritation, addressing GERD’s pathophysiology more effectively than nutritional interventions.

Choice B reason: Intravenous PPIs (e.g., pantoprazole) are standard for severe GERD, inhibiting H+/K+-ATPase in parietal cells, reducing acid secretion. This promotes esophageal healing when oral famotidine fails. IV delivery ensures rapid onset, critical for controlling worsening symptoms, preventing complications like esophagitis or Barrett’s esophagus in acute settings.

Choice C reason: Total parenteral nutrition (TPN) bypasses the gut, used for conditions like bowel obstruction, not GERD, which involves acid reflux from sphincter dysfunction. TPN does not address acid production. PPIs target the pathophysiological cause, reducing esophageal acid exposure, making TPN irrelevant for GERD management.

Choice D reason: A nasogastric tube with suction removes gastric contents but does not treat GERD’s acid reflux, caused by lower esophageal sphincter dysfunction. It risks aspiration and is temporary. PPIs effectively reduce acid, preventing esophageal damage, making them the preferred treatment for severe GERD exacerbation.

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The nurse observes an adult client perform a return demonstration of diaphragmatic breathing. The client inhales while holding the abdomen, then removes the hand to allow expansion of the abdomen during exhalation. Which action should the nurse take after observing the client’s demonstration?

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Naxlex Comprehensive Predictor Exams

Which instruction should the nurse include in the discharge teaching plan of a client who is prescribed ibuprofen for arthritic pain?

Correct Answer is B

Explanation

A client with gastroesophageal reflux disorder (GERD), who has been self-medicating with famotidine for the past week, is admitted to the acute care center because the symptoms have worsened. The nurse should anticipate which treatment?

Correct Answer is B

Explanation

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