What is the most effective intervention for a client with shortness of breath and a history of heart failure?

Correct Answer: B

Rationale: The correct answer is B: Provide oxygen therapy. For a client with shortness of breath and a history of heart failure, oxygen therapy is the most effective intervention as it helps improve oxygenation and relieve respiratory distress. Administering diuretics may help manage fluid retention but does not directly address the breathing difficulty. Encouraging deep breathing may be beneficial for some respiratory conditions but may not be sufficient for a client with heart failure and shortness of breath. Applying oxygen therapy is similar to providing oxygen therapy and can help improve oxygen levels, but providing oxygen therapy is more specific and effective in this case.

Correct Answer: A

Rationale: The correct first step is to administer pain relief (Choice A) because addressing the client's pain is a top priority to ensure their comfort and well-being. Pain management is crucial post-surgery to prevent complications and aid in recovery. Monitoring vital signs (Choice B) is important but should follow pain relief to ensure the client's stability. Assessing the wound (Choice C) is necessary but not the immediate priority when the client is in acute pain. Applying a warm compress (Choice D) may provide temporary relief but does not address the underlying cause of the pain. Therefore, administering pain relief is the most appropriate initial action to alleviate the client's discomfort and start the healing process effectively.

Correct Answer: A

Rationale: The correct answer is A: Administer IV fluids. In shock, the priority nursing action is to restore intravascular volume to improve tissue perfusion. IV fluids help increase blood pressure and cardiac output, addressing the underlying cause of shock. Monitoring vital signs (B) is important but administering fluids takes precedence. Administering fluids (C) is a general term and does not specify the urgency of IV fluids. Administering blood transfusion (D) may be indicated in certain types of shock but is not the initial priority.

Correct Answer: D

Rationale: The correct answer is D: Encourage deep breathing. This is because encouraging deep breathing can help alleviate anxiety and promote relaxation, which can be beneficial in managing severe chest pain. Administering nitroglycerin (A) should only be done after assessing the client's condition and confirming it is safe to do so. Providing pain relief (B) may be necessary, but addressing the root cause of the pain should be the priority. Monitoring ECG (C) is important but should come after ensuring the client's immediate needs are addressed.

Correct Answer: A

Rationale: The correct answer is A: Administer epinephrine. Epinephrine is the first-line treatment for severe allergic reactions as it acts quickly to reverse symptoms like airway swelling and low blood pressure. It helps to open airways and increase blood pressure. Antihistamines (B) are not as fast-acting as epinephrine in severe reactions. Applying a cold compress (C) is not effective in treating anaphylaxis. Placing the client in a supine position (D) can worsen breathing difficulties. Administering epinephrine is crucial in managing severe allergic reactions promptly and effectively.