Difficulty: Medium
Average Score: 72%
Simulated
Passage / Scenario
Vital SignsNurses' Notes
Provider Prescriptions
0900:
Temperature 38.0┬░ C (100.4┬░ F)
Heart rate 94/min
Respiratory rate 18/min
Blood pressure 110/88 mm Hg
Pulse oximetry 97% on room air
0915:
Temperature 38.0┬░ C (100.4┬░ F)
Heart rate 100/min Respiratory rate 20/min
Blood pressure 106/80 mm Hg
Pulse oximetry 94% on room air
0920:
Pulse oximetry 97% on room air
Click to highlight the action that would be appropriate for the care of the client. Each body system may support more than 1 potential action.
Correct answer
B,C,D,E,F
Rationale
To determine the appropriate actions for the care of the client, we need to consider the client's overall well-being and potential needs.
B: Encouraging deep-breathing exercises helps improve lung function and oxygenation, aiding in respiratory health.
C: Checking for pain is crucial to address any discomfort or underlying issues that may affect the client's well-being.
D: Encouraging the client to increase fiber in their diet promotes gastrointestinal health and aids in preventing constipation.
E: Promoting intake of oral fluids is essential for hydration and overall health maintenance.
F: Applying barrier ointment after bowel movements helps protect the skin and prevent irritation.
These actions encompass respiratory, pain assessment, nutrition, hydration, and skin care, covering a holistic approach to the client's care needs.
B: Encouraging deep-breathing exercises helps improve lung function and oxygenation, aiding in respiratory health.
C: Checking for pain is crucial to address any discomfort or underlying issues that may affect the client's well-being.
D: Encouraging the client to increase fiber in their diet promotes gastrointestinal health and aids in preventing constipation.
E: Promoting intake of oral fluids is essential for hydration and overall health maintenance.
F: Applying barrier ointment after bowel movements helps protect the skin and prevent irritation.
These actions encompass respiratory, pain assessment, nutrition, hydration, and skin care, covering a holistic approach to the client's care needs.