Module 8 Flashcards

1
Q

The nurse is caring for a client who has experienced significant pain following a surgical procedure. Which nursing interventions are appropriate? Select all that apply.
Delegate pain assessment to the UAP.
Assess for pain control 30 minutes after administering an analgesic.
Consider cultural implications of the perception of pain. Infer that the client who does not complain has no pain.
Provide pain medication before activity that may increase pain.

A

Provide pain medication before activity that may increase pain.
Assess for pain control 30 minutes after administering an analgesic.
Consider cultural implications of the perception of pain.

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2
Q

The nurse is caring for a client during the first 12 hours of receiving epidural analgesia and assesses the client every hour. Along with vital signs, which best describes the priority of the hourly assessment?

A

Respiratory status, oxygen saturation, pain, and sedation level
Explanation:
Respiratory status, oxygen saturation, pain, and sedation level are the best description of the priority of the hourly assessments for this client. The priority concern for this client is the risk of respiratory depression because of the use of analgesia; therefore, the priority assessments during the first 12 hours of epidural therapy include assessing the client’s vital signs, respiratory status, pain status, sedation level, oxygen saturation at least once per hour during the first 12 hours of therapy. If there are no complications after 12 hours, the assessments should continue every 2 hours and then decrease per facility policy. Airway, breathing, and circulation are the top priorities in the care of any client, and in this client, breathing is a concern because of the risk of respiratory depression from the epidural analgesia

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3
Q

The nurse is teaching a client how to manage postoperative pain through a patient controlled analgesia (PCA) pump. The nurse determines that additional teaching is needed when the client make which statement?
“This will allow me to control my own pain medication.”
“I should only take medication when my pain is intense.”
“I give myself the pain medication by pushing the button.”
“The pump is programmed to limit the chance of overmedicating.”

A

“I should only take medication when my pain is intense.”

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4
Q

A client with recurrent episodes of migraine headaches tells the nurse, “I am not comfortable taking medication for my pain.” Which pain relief technique(s) can the nurse teach the client to implement at home?

A

relaxation
massage
meditation
biofeedback

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5
Q

A client has been admitted to a post-surgical unit with a patient-controlled analgesia (PCA) system. Which statement is true of this medication delivery system?

A

The dose that is delivered when the client activates the machine is preset.

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6
Q

A nurse is caring for a client who received naloxone to reverse respiratory depression due to opioid therapy. The client is now complaining of pain and wishes to receive the newly prescribed pain medication. What is the correct action by the nurse?

A

Administer the medication if respiratory rate is > 9.

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7
Q

A client reports severe pain following a mastectomy. The nurse would expect to administer what type of pain medication to this client?

A

Opioid analgesics

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8
Q

The nurse manager hears a nurse and a nurse aide talking about a female client who reports pain of 8 out of 10 on a 1-10 scale after a Caesarean birth to deliver twins. The nurse states, “I don’t believe this client has any pain at all. I’m sure she is just drug seeking.” What is the appropriate nurse manager action?

A

Ask the nurse to speak privately for a moment, and educate about bias in pain treatment.

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9
Q

When asking an older adult client about abdominal pain, the client reports, “I don’t want to be a bother because nothing hurts too much.” The nurse notes that the client grimaces and splints the abdomen when moving. What is the appropriate nursing action?

A

Gently mention that the client appears to be experiencing pain that can be treated

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10
Q

A client is prescribed pain medication every 4 to 6 hours as needed. When the nurse enters the client’s room to administer the medication, the client is laughing with visitors. The client’s pulse rate is 64, respirations 16, and blood pressure 120/80. The client reports pain and wants the medication. What is the most appropriate action by the nurse?

A

Administer the pain medication.

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11
Q

The nurse is performing an assessment for a client related to pain. To determine the need for pain medication, on what primary source will the nurse base the decision?

A

verbal report

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12
Q

The nurse recognizes which statement is true of chronic pain?

A

It may cause depression in clients

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13
Q

The nurse is taking a history for a pregnant client who has been seen for chronic headaches for 2 years. Today, the client reports a headache that feels different than the normal headaches she has experienced in the past. Which assessment question helps the nurse assess quality of pain?

A

“Can you describe the type of pain you are having?”

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14
Q

The wife of a client with cancer is concerned that her husband’s breakthrough doses of morphine have recently needed to be larger and more frequent in order for him to achieve pain relief. The nurse would recognize that the client is likely showing the effects of:

A

tolerance.

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15
Q

A male college student age 20 years has been experiencing increasingly sharp pain in the right, lower quadrant of his abdomen over the last 12 hours. A visit to the emergency department and subsequent diagnostic testing have resulted in a diagnosis of appendicitis. What category of pain is the client most likely experiencing?

A

visceral pain
Explanation:
Visceral pain occurs when organs stretch abnormally and become distended, ischemic, or inflamed. Appendicitis is characterized by inflammation of the vermiform appendix. Cutaneous pain is superficial. Somatic pain is more commonly associated with tendons, ligaments, and bones. Referred pain is perceived distant from its point of origin, but this client’s pain is sensed near the location of his appendix.

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16
Q

A client with an amputated arm tells a nurse that sometimes he experiences throbbing pain or a burning sensation in the amputated arm. What kind of pain is the client experiencing?

A

neuropathic pain
Explanation:
The client is experiencing neuropathic pain or functional pain. Neuropathic pain is often experienced days, weeks, or even months after the source of the pain has been treated and resolved. In cutaneous pain, the discomfort originates at the skin level. In visceral pain, the discomfort arises from internal organs caused from a disease or injury. In chronic pain, the discomfort lasts longer than 6 months.

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17
Q

A client has been prescribed patient-controlled analgesia and the nurse is setting up the system and educating the client about safe and effective use of PCA. Which teaching point should the nurse provide to the client?

A

“The pump is programmed with safeguards to limit the possibility overmedication.”

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18
Q

A client in pain believes that the pain is a punishment from God, and feels angry and resentful. Which is the most appropriate action by the nurse?

A

Encourage client to confer with a spiritual advisor.

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19
Q

A middle-age client with cancer has been prescribed patient-controlled analgesia (PCA). The nurse caring for the client explains the functioning of PCA. What is the main advantage of PCA?

A

The client is actively involved in pain management.

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20
Q

After sedating a client, the nurse assesses that the client is frequently drowsy and drifts off during conversations. What number on the sedation scale would the nurse document for this client?

A

3
Explanation:
The Pasero Opioid-Induced Sedation Scale that can be used to assess respiratory depression is as follows:
1 = awake and alert; no action necessary
2 = occasionally drowsy but easy to arouse; requires no action
3 = frequently drowsy and drifts off to sleep during conversation; decrease the opioid dose
4 = somnolent with minimal or no response to stimuli; discontinue the opioid and consider use of naloxone.

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21
Q

You are a new nurse in an ambulatory care setting. You know that the Joint Commission requires that pain be addressed at each visit. When is the most appropriate time to do so?

A

When obtaining patient vital signs

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22
Q

A client who is living with chronic pain has received a health care provider’s order for TENS. When applying the device to the client’s skin, the nurse should do what action?

A

Start with the lowest intensity and gradually increase it to the appropriate level.

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23
Q

The nurse is caring for a client who reports pain as 10, on a 0 to 10 scale. After the administration of an opioid anesthesia, the nurse observes the client’s respiratory rate decrease to 8 breaths per minute. What is the priority action by the nurse?

A

Administration of 0.4 mg of naloxone
Explanation:
The client is experiencing impending respiratory arrest due to the effect of the medication and this should be reversed immediately prior to arrest. This is the priority action and will correct the respiratory depression immediately. CPR is not indicated at this time, because the client is not in full arrest. Placing the client in the supine position may decrease respirations further.

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24
Q

While caring for a client with chronic pain, the nurse talks with a family member. Which family member statement does the nurse identify as consistent with caregiver role strain?

A

“Sometimes it seems like I can never get a moment to myself.”

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25
Q

Which principle should the nurse integrate into the pain assessment and pain management of pediatric clients?

A

Pain assessment may require multiple methods in order to ensure accurate pain data.

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26
Q

A nurse is caring for a client who is receiving morphine via a patient controlled analgesia (PCA) pump. When assessing the client, she notes that his respiratory rate is 4. What should the nurse do first?

A

Stop the PCA pump.
Explanation:
A side effect of morphine is respiratory depression. In this situation, the nurse should first stop the PCA pump and then notify the physician. Naloxone is used to reverse the sedative effects of opioids, but this is not the first step.

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27
Q

A nurse is taking care of a client who requests acetaminophen to help with a headache. The nurse checks to see if there is an order for acetaminophen and notices that the client is able to have 650 mg every 4 hours as needed for pain. What type of order is this considered?

A

PRN order

28
Q

The nurse is assessing a client who is experiencing pain. The nurse notes the client is experiencing acute rather than chronic pain when the client makes which statement?

A

“The pain is really sharp in this one spot.”

Explanation:
Acute pain can be differentiated from chronic pain because it is specific and localized, whereas chronic pain tends to be nonspecific and generalized. Clients experiencing acute pain will indicate a recent onset whereas chronic pain has a remote onset. Acute pain is associated with sympathetic nervous system responses such as hypertension, tachycardia, restlessness, and anxiety, whereas chronic pain features the absence of autonomic nervous system responses and manifests with depression and irritability. Acute pain responds favorably when pain medication is administered. Chronic pain requires more frequent and higher doses of pain medication to elicit a positive response due to the threshold people build to the efficacy over time.

29
Q

A client reports after a back massage that his lower back pain has decreased from 8 to 3 on the pain scale. Which opioid neuromodulator does the nurse know is released with skin stimulation and is more than likely responsible for this increased level of comfort?

A

Endorphins
Explanation:
Endorphins and enkephalins are opioid neuromodulators that are powerful pain-blocking chemicals, which have prolonged analgesic effects and produce euphoria. It is thought that certain measures, such as skin stimulation and relaxation techniques, release endorphins. Serotonin is an important chemical and neurotransmitter in the human body. It is believed that serotonin helps regulate mood and social behavior, appetite and digestion, sleep, memory, and sexual desire and function. Melatonin is a hormone that is produced by the pineal gland in humans and animals and regulates sleep and wakefulness. Dopamine is a neurotransmitter that helps control the brain’s reward and pleasure centers.

30
Q

A nurse administers pain medication to clients on a med-surg ward. The client that would benefit from a PRN drug regimen as an effective method of pain control would be the client:

A

in the postoperative stage with occasional pain.

31
Q

The nurse is caring for a client with chronic back pain due to inoperable spinal stenosis. Which strategies, suggested by the nurse, may help to decrease the client’s back pain?

A

Adding the use of hot or cold packs for pain control

32
Q

A nurse is caring for a client who complains of an aching pain in the abdomen. The nurse also noted that the client is guarding the area. The client is experiencing:

A

visceral pain.
Explanation:
The client is experiencing visceral pain, which is poorly localized and originates in body organs in the thorax, cranium, and abdomen. A reflex contraction or spasm of the abdominal wall, called guarding, may occur as a protective mechanism to prevent additional trauma to underlying structures. In cutaneous pain, the discomfort originates at the skin level, and is a commonly experienced sensation resulting from some form of trauma. Somatic pain develops from injury to structures such as muscles, tendons, and joints. Neuropathic pain is experienced days, weeks, or even months after the source of the pain has been treated and resolved.

33
Q

The nurse is admitting a dying client with osteosarcoma. Which nursing action is priority?

A

Examine the effectiveness of the current pain regimen
Explanation:
When a client has a painful diagnosis and is nearing the end of life, pain management is the priority. Education is important along with assessment and comparison, however, these are not the priority.

34
Q

A nurse is caring for an asthmatic client who requires a low concentration of oxygen. Which delivery device should the nurse use in order to administer oxygen to the client?

A

nasal cannula

35
Q

A client who was prescribed CPAP reports nonadherence to treatment. What is the priority nursing intervention?

A

Ask the client what factors contribute to nonadherence

36
Q

Upon evaluation of a client’s medical history, the nurse recognizes that which condition may lead to an inadequate supply of oxygen to the tissues of the body?

A

chronic anemia

37
Q

The nurse is caring for a client at risk for pneumonia after having major abdominal surgery. Which nursing instruction(s) is essential for the use of an incentive spirometer?

A

Assist the client to an upright or semi-Fowler position.
Instruct the client to exhale normally and then place lips securely around the mouthpiece.
Splint the abdomen with a pillow to decrease discomfort prior to use.
Encourage the client to complete breathing exercises about 5 to 10 times every 1 to 2 hours, if possible.

38
Q

The nurse is conducting a respiratory assessment of a client age 71 years who has been recently admitted to the hospital unit. Which assessment finding should the nurse interpret as abnormal?
fine crackles to the bases of the lungs bilaterally
respiratory rate of 18 breaths per minute
resonance on percussion of lung fields
vesicular breath sounds audible over peripheral lung fields

A

fine crackles to the bases of the lungs bilaterally

39
Q

The nurse auscultates a client with soft, high-pitched popping breath sounds on inspiration. The nurse documents the breath sounds heard as:

A

crackles.
Explanation:
Crackles, frequently heard on inspiration, are soft, high-pitched discontinuous (intermittent) popping sounds. Wheezes are continuous musical sounds, produced as air passes through airways constricted by swelling, narrowing, secretions, or tumors. Vesicular sounds are low-pitched, soft sounds heard over peripheral lung fields. Bronchovesicular sounds are medium-pitched blowing sounds heard over the major bronchi.

40
Q

A client with a history of chronic obstructive pulmonary disease (COPD) has been ordered oxygen at 3 L/min as needed for treatment of dyspnea. What delivery mode is most appropriate to this client’s needs?

A

Nasal cannula

41
Q

The nurse schedules a pulmonary function test to measure the amount of air left in a client’s lungs at maximal expiration. What test does the nurse order?

A
Residual Volume (RV)
  Explanation:
During a pulmonary function test the amount of air left in the lungs at the end of maximal expiration is called residual volume. Tidal volume refers to the total amount of air inhaled and exhaled with one breath. Total lung capacity is the amount of air contained within the lungs at maximum inspiration. Forced expiratory volume measures the amount of air exhaled in the first second after a full inspiration; it can also be measured at 2 or 3 seconds.
42
Q

The nurse is caring for a postoperative client who has a prescription for meperidine 75 mg intramuscularly (IM) every 4 hours as needed for pain. Before and after administering meperidine, the nurse would assess which most important sign?

A

Respiratory rate and depth

43
Q

A health care provider orders the collection of a sputum specimen from a client with a suspected bacterial infection. Which action best ensures a usable specimen?

A

Instruct the client to inhale deeply and then cough

44
Q

The nurse is performing an arterial blood gas sampling on a client at 10:45. The nurse educator intervenes if which action is taken by the nurse?

A

The nurse performs the Allen test after blood sample is taken.
Explanation:
The Allen test is done before puncture to ensure adequate ulnar blood flow when using the radial artery. The arterial specimen is immediately placed on ice and taken to the laboratory. The radial, brachial, or femoral arteries are usually the sites of choice for an arterial blood sampling. The nurse should apply pressure for 5 to 10 minutes, longer if the client is on anticoagulant therapy.

45
Q

Which guideline is recommended for determining suction catheter depth when suctioning an endotracheal tube?

A

Guidelines to determine suction catheter depth include the following: Using a suction catheter with centimeter increments on it, insert the suction catheter into the endotracheal tube until the centimeter markings on both the endotracheal tube and catheter align, and insert the suction catheter no further than an additional 1 cm past the length of the endotracheal tube. Combine the length of the endotracheal tube and any adapter being used, and add an additional 1 cm. Using a spare endotracheal or tracheostomy tube of the same size as being used for the client, insert the suction catheter to the end of the tube and note the length of catheter used to reach the end of the tube. For a closed system, combine the length of the endotracheal or tracheostomy tube and any adapter being used, and add an additional 1 cm.

46
Q

The nurse is caring for a client admitted for a mild exacerbation of asthma who has been prescribed portable oxygen at 2 L/min. What delivery device will the nurse select to apply oxygen to the client?

A

nasal cannula

47
Q

The nurse assesses a client and detects the following findings: difficulty breathing, increased respiratory and pulse rates, and pale skin with regions of cyanosis. What condition would the nurse suspect as causing these respiratory alterations?

A

Hypoxia
Explanation:
Hypoxia is a condition in which an inadequate amount of oxygen is available to cells. Difficulty breathing, increased respiratory and pulse rates, and pale skin with regions of cyanosis are all signs of hypoxia. Hyperventilation is an increased rate and depth of ventilation, above the body’s normal metabolic requirements. Perfusion refers to the process by which oxygenated capillary blood passes through body tissues. Atelectasis refers to collapsed alveoli.

48
Q

The nurse is educating an adolescent with asthma on how to use a metered-dose inhaler. Which education point follows recommended guidelines?

A

Be sure to shake the canister before using it.
Explanation:
A metered-dose inhaler (MDI) delivers a controlled dose of medication with each compression of the canister. The canister must be shaken to mix the medication properly. MDIs are inhaled through the mouth, into the lungs. The medication should be inhaled slowly to ensure a sufficient dose enters the lungs. If the order is for two sprays, these sprays are administered with one spray for each breath. The inhaled breath should be held briefly after each spray in order to prevent immediately exhaling the medication.

49
Q

A client with chronic obstructive pulmonary disease (COPD) requires low flow oxygen. How will the oxygen be administered?

A

nasal cannula

50
Q

A woman comes to the emergency room with her 2-year-old son. She states he woke up and had a loud barking cough. The child is suffering from:

A

croup.
Explanation:
Croup and epiglottitis are common in young children. The child has an obstruction of the upper airways, with swelling of the throat tissue.

51
Q

An older resident at a long-term care facility has been placed on oxygen via a partial rebreather mask due to COVID-19. While helping the resident prepare for sleep, the nurse notices the mask is no longer fitting properly. Which question should the nurse prioritize?

A

“Is your mask causing discomfort?”

52
Q

What assessments would a nurse make when auscultating the lungs?

A

air flow through the respiratory passages

53
Q

A nurse is reading a journal article about pollutants and their effect on an individual’s respiratory function. Which problem would the nurse most likely identify as an effect of exposure to automobile pollutants?

A

Bronchitis

54
Q

The nurse is caring for a client who is diagnosed with Impaired Gas Exchange. While performing a physical assessment of the client, which data is the nurse likely to find, keeping in mind the client’s diagnosis?

A

high respiratory rate
Explanation:
A client diagnosed with Impaired Gas Exchange has difficulty in breathing, so the nurse is likely to find a high respiratory rate. As a compensatory mechanism to impairment in gas exchange, the peripheral temperature drops, and the pulse rate and blood pressure increase.

55
Q

A client with a chest tube wishes to ambulate to the bathroom. What is the appropriate nursing response?

A

“I can assist you to the bathroom and back to bed.”
Explanation:
The client can move in bed, and ambulate while carrying the drainage system, as long as he or she has orders to do so. The nurse should supervise ambulation to the bathroom and back to bed while the client has the drain inserted to make sure it stays intact and to monitor for safety.

56
Q

The nurse is auscultating the lungs of a client and detects normal vesicular breath sounds. What is a characteristic of vesicular breath sounds?

A

They are low-pitched, soft sounds heard over peripheral lung fields.

57
Q

Which dietary guideline would be appropriate for the older adult homebound client with advanced respiratory disease who informs the nurse that she has no energy to eat?

A

Eat smaller meals that are high in protein.
Explanation:
The client should consume a diet in which the body can produce plasma proteins. The client should have sufficient caloric and protein intake for respiratory muscle strength.

58
Q

The nurse is suctioning a client’s tracheostomy when the tracheostomy becomes dislodged and the nurse is unable to replace it easily. What is the nurse’s most appropriate response?

A

Maintain the client’s oxygenation and alert the health care provider immediately.

59
Q

The nurse is teaching the client with a pulmonary disorder about deep breathing. The client asks, “Why is it important to start by breathing through my nose, then exhaling through my mouth?” Which appropriate response would the nurse give this client?

A

“Breathing through your nose first will warm, filter, and humidify the air you are breathing.”

60
Q

A nurse assessing a client’s respiratory status gets a weak signal from the pulse oximeter. The client’s other vital signs are within reference ranges. What is the nurse’s best action?

A

Warm the client’s hands and try again.

61
Q

A client has been put on oxygen therapy because of low oxygen saturation levels in the blood. What should the nurse use to regulate the amount of oxygen delivered to the client?

A

flow meter
Explanation:
The nurse should use a flow meter to regulate the amount of oxygen delivered to the client. A flow meter is a gauge used to regulate the amount of oxygen delivered to the client and is attached to the source of oxygen. An oxygen analyzer is a device that measures the percentage of delivered oxygen to determine if the client is receiving the amount prescribed by the physician. An adhesive nasal strip increases the nasal diameter and promotes easier breathing. A nasal cannula is a hollow tube used for delivering a small concentration of oxygen. However, these devices are not used to regulate the amount of oxygen delivered to the client.

62
Q

The nurse auscultates the lungs of a client with asthma who reports shortness of breath, sore throat, and congestion. Which finding does the nurse expect to document?

A

Wheezing
Explanation:
The nurse expects to document wheezing in the lungs of a client with asthma, which would be more pronounced when the client has a respiratory infection. Wheezing is a high-pitched, musical sound heard primarily during expiration but may also be heard on inspiration. Wheezing is caused by air passing through constricted passages caused by swelling or secretions. Stridor and crackles are other abnormal breath sounds caused by fluid, infection, or inflammation in the lungs. Absent breath sounds are not normally found in asthmatic clients; they are characteristic of pneumonia.

63
Q

A nurse assessing a client’s respiratory effort notes that the client’s breaths are shallow and 8 per minute. Shortly after, the client’s respirations cease. Which form of oxygen delivery should the nurse use for this client?

A

Ambu bag
Explanation:
If the client is not breathing with an adequate rate and depth, or if the client has lost the respiratory drive, a manual resuscitation bag (Ambu bag) may be used to deliver oxygen until the client is resuscitated or can be intubated with an endotracheal tube. Oxygen masks may cover only the nose and mouth and can vary in the amount of oxygen delivered. A nasal oxygen cannula is a device that consists of a plastic tube that fits behind the ears, and a set of two prongs that are placed in the nostril. An oxygen tent is a tentlike enclosure within which the air supply can be enriched with oxygen to aid a client’s breathing. Oxygen masks, nasal cannula, and oxygen tents are used for clients who have a respiratory drive.

64
Q

A client who uses portable home oxygen states, “I still like to smoke cigarettes every now and then.” What is the appropriate nursing response?

A

“You should never smoke when oxygen is in use.”
Explanation:
The nurse will educate the client about the dangers of smoking when oxygen is in use. Oxygen is not flammable, but it oxidizes other materials. Other answers are inappropriate.

65
Q

A client has edema of the feet and ankles, along with crackles in the lower lobes and a frothy, productive cough. The client is suffering from:

A

congestive heart failure.
Explanation:
A client who has edema and a cough that is productive with frothy sputum is manifesting heart failure.q

66
Q

The nurse is preparing discharge teaching for a client who has chronic obstructive pulmonary disease (COPD). Which teaching about deep breathing will the nurse include?

A

“Inhale slowly over three seconds, purse your lips, contract abdominal muscles, and exhale slowly.”