Which action should a nurse take when a patient is experiencing dyspnea?

Correct Answer: A

Rationale: Elevating the head of the bed helps a patient with dyspnea by reducing chest pressure, allowing better lung expansion, and easing breathing effort through gravitational assistance. This position, often Fowler's, is a first-line intervention for respiratory distress. Large doses of pain medication might sedate the patient, worsening breathing, and aren't indicated unless pain is the cause. Dim lighting may calm them but doesn't address the physical issue. Vigorous exercise is dangerous during dyspnea, as it increases oxygen demand. Nurses prioritize this simple, effective adjustment to stabilize breathing and improve oxygenation, often before further medical steps.

Correct Answer: A

Rationale: A splint immobilizes an injured limb to stabilize fractures or sprains, reducing movement that could worsen damage or pain, and promoting healing. Exerting pressure isn't its role compression bandages do that if needed. Encouraging joint movement contradicts immobilization's purpose; it's about rest, not exercise. Hiding the injury isn't practical or relevant it's a medical tool, not a cover. Nurses apply splints to protect the injury site, ensuring proper alignment and safety until further treatment, a key step in acute care management.

Correct Answer: D

Rationale: Beginning collection before the patient starts urinating ensures a midstream sample, capturing cleaner urine less contaminated by initial urethral bacteria, vital for accurate analysis. An unlabeled sterile container risks mix-ups, compromising results. Timing matters for specific tests (e.g., first morning urine), not 'any time.' Cleansing after collection is backward pre-cleaning prevents contamination. Nurses use this technique, often with a sterile cup, to provide reliable diagnostic data, avoiding false positives from skin flora, a critical detail in assessing kidney or infection status.

Correct Answer: C

Rationale: Elevating the arm with a new cast reduces swelling by aiding venous return, easing pressure inside the cast for comfort and preventing complications like compartment syndrome. Using the arm normally risks damage or delayed healing. Pressing the cast can worsen pain or shift fractures. Keeping it moist invites skin breakdown or infection casts must stay dry. Nurses use pillows for elevation, monitor circulation, and educate on care, balancing comfort with healing safety in early cast stages.

Correct Answer: C

Rationale: Explaining the process and providing privacy during a bed bath promotes comfort by reducing anxiety and preserving dignity, key for a vulnerable patient. Cold water chills, not invigorates, causing discomfort in a controlled setting. Extremely hot water risks burns, especially with impaired sensation. Limiting soap doesn't save resources meaningfully and compromises cleanliness. Nurses use warm water, curtains, and clear communication to make this intimate task soothing and respectful, enhancing physical and emotional well-being.