a nurse is planning to instruct a client on how to perform pursed lip breathing which of the following should the nurse include in the plan of care
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ATI RN

ATI Fundamentals Proctored Exam Quizlet

1. A client is being instructed on how to perform pursed-lip breathing. Which of the following should be included in the plan of care?

Correct answer: C

Rationale: Pursed-lip breathing is a breathing technique that involves inhaling slowly through the nose and exhaling gently through pursed lips. This technique helps improve breathing efficiency and can be beneficial for individuals with respiratory conditions. Instructing the client to take a deep breath in through the nose is essential for proper execution of pursed-lip breathing, making choice C the correct answer.

2. What is the most common psychogenic disorder among elderly individuals?

Correct answer: A

Rationale: Depression is the most common psychogenic disorder among elderly individuals. It can manifest as persistent feelings of sadness, hopelessness, and loss of interest in activities that were once enjoyed. Elderly individuals may also experience changes in appetite, sleep disturbances, and difficulty concentrating. Detecting and addressing depression in the elderly is crucial for their overall well-being and quality of life.

3. Which of the following patients is at greatest risk for developing pressure ulcers?

Correct answer: B

Rationale: The correct answer is B. An elderly patient who is incontinent, bedridden, and suffering from a serious illness like gastric cancer is at the highest risk for developing pressure ulcers. Being bedridden and incontinent increases the pressure on certain areas of the body, leading to tissue damage and the development of pressure ulcers. Additionally, the patient's age and underlying health condition further contribute to their risk. It is crucial to identify and address such risk factors promptly to prevent the occurrence of pressure ulcers in vulnerable patients.

4. Which of the following is included in Orem’s theory?

Correct answer: A

Rationale: Orem's theory, also known as the Self-Care Deficit Nursing Theory, focuses on individuals' ability to perform self-care to maintain health and well-being. One specific component of this theory is the maintenance of a sufficient intake of air, which is crucial for sustaining life and overall health. Option A is the correct choice as it directly relates to meeting physiological needs, such as the intake of air, to support optimal functioning and health. Choices B, C, and D are incorrect as they do not specifically align with Orem's emphasis on self-care and meeting physiological requirements.

5. Which of the following blood tests should be performed before a blood transfusion?

Correct answer: B

Rationale: Before administering a blood transfusion, it is crucial to perform blood typing and cross-matching to ensure compatibility between the donor's blood and the recipient's blood. This process helps prevent adverse reactions such as transfusion reactions, which can be life-threatening. Prothrombin and coagulation time, bleeding and clotting time, as well as CBC and electrolyte levels are important tests in other clinical contexts, but for blood transfusions, blood typing and cross-matching are essential to ensure patient safety.

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