Nokea
What is the most important action when caring for a client with respiratory distress?
- A. Administer oxygen
- B. Administer corticosteroids
- C. Administer bronchodilators
- D. Administer analgesics
Correct Answer: A
Rationale: Administering oxygen is the most important action for a client with respiratory distress because it helps improve oxygen levels in the blood and supports breathing. Oxygen therapy can prevent hypoxia and reduce respiratory workload. Corticosteroids, bronchodilators, and analgesics may be beneficial in specific situations, but they are not the primary intervention for respiratory distress. Corticosteroids reduce inflammation, bronchodilators help open airways, and analgesics provide pain relief but do not directly address the underlying issue of inadequate oxygenation. Administering oxygen should always be the first priority in managing respiratory distress.
You may also like to solve these questions
What is the first intervention when a client is showing signs of shock after surgery?
- A. Administer blood transfusion
- B. Monitor for arrhythmias
- C. Administer oxygen
- D. Encourage deep breathing
Correct Answer: B
Rationale: The correct answer is B: Monitor for arrhythmias. This is because in a client showing signs of shock after surgery, the priority is to assess for any cardiac complications such as arrhythmias, which can be life-threatening. Monitoring for arrhythmias allows prompt identification and intervention. Administering a blood transfusion (A) may be necessary in some cases of shock but is not the first intervention. Administering oxygen (C) may also be necessary, but addressing cardiac complications takes precedence. Encouraging deep breathing (D) is not a priority in managing shock-related complications.
A nurse is providing education to a patient with hypertension. Which of the following lifestyle changes should the nurse prioritize?
- A. Increasing physical activity and reducing salt intake.
- B. Increasing alcohol consumption.
- C. Decreasing physical activity.
- D. Increasing sodium intake.
Correct Answer: A
Rationale: The correct answer is A: Increasing physical activity and reducing salt intake. Firstly, increasing physical activity helps lower blood pressure by improving heart health and circulation. Secondly, reducing salt intake helps decrease fluid retention and lower blood pressure. The other choices are incorrect because B: Increasing alcohol consumption can raise blood pressure, C: Decreasing physical activity is counterproductive, and D: Increasing sodium intake can lead to higher blood pressure due to fluid retention. Prioritizing physical activity and reducing salt intake are evidence-based lifestyle changes to manage hypertension effectively.
A nurse is caring for a patient with a history of heart failure. The nurse should monitor for signs of which of the following complications?
- A. Hypoglycemia.
- B. Pulmonary edema.
- C. Anemia.
- D. Hypertension.
Correct Answer: B
Rationale: The correct answer is B: Pulmonary edema. In heart failure, the heart is unable to pump effectively, leading to fluid buildup in the lungs causing pulmonary edema. This can result in symptoms such as shortness of breath, coughing, and wheezing. Monitoring for pulmonary edema is crucial in heart failure management to prevent respiratory distress and worsening heart function.
Rationale:
A: Hypoglycemia - While patients with heart failure may be at risk for metabolic abnormalities, hypoglycemia is not a common complication directly related to heart failure.
C: Anemia - Anemia can occur in heart failure due to reduced oxygen-carrying capacity of the blood, but it is not a direct complication that requires immediate monitoring like pulmonary edema.
D: Hypertension - Heart failure is characterized by a reduced ability of the heart to pump blood effectively, leading to decreased cardiac output. Therefore, hypertension is not typically a complication seen in heart failure patients.
A nurse is providing education to a patient with chronic kidney disease. Which of the following dietary recommendations should the nurse prioritize?
- A. Increase protein intake.
- B. Increase potassium intake.
- C. Limit phosphorus and potassium intake.
- D. Decrease fluid intake.
Correct Answer: C
Rationale: The correct answer is C: Limit phosphorus and potassium intake. Patients with chronic kidney disease often have difficulty excreting phosphorus and potassium, leading to potential complications. Limiting phosphorus and potassium intake can help prevent further kidney damage and maintain electrolyte balance. Prioritizing this dietary recommendation is crucial for managing the progression of the disease.
Incorrect choices:
A: Increasing protein intake can put additional strain on the kidneys and may lead to further deterioration of kidney function.
B: Increasing potassium intake can be dangerous for patients with chronic kidney disease as they may have difficulty regulating potassium levels.
D: Decreasing fluid intake may be necessary in some cases, but it is not the priority in terms of managing chronic kidney disease.
What is the first action the nurse should take when a client develops a deep vein thrombosis (DVT)?
- A. Elevate the affected leg
- B. Apply compression stockings
- C. Provide leg elevation
- D. Administer compression therapy
Correct Answer: A
Rationale: The correct answer is A: Elevate the affected leg. This is the first action because elevating the leg helps reduce swelling and improve blood flow, reducing the risk of complications from the DVT. It also helps alleviate pain.
Choice B: Applying compression stockings can be helpful in preventing DVT, but it is not the first action to take once it has developed.
Choice C: Providing leg elevation is similar to choice A, but it lacks the specificity of elevating the affected leg to address the DVT directly.
Choice D: Administering compression therapy may be necessary, but it is not the initial action to take when a client develops a DVT.