a nurse is assisting a provider with the removal of a chest tube which of the following should the nurse instruct the client to do a nurse is assisting a provider with the removal of a chest tube which of the following should the nurse instruct the client to do
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ATI Fundamentals

1. During the removal of a chest tube, what should the nurse instruct the client to do?

Correct answer: Perform the Valsalva maneuver.

Rationale: During the removal of a chest tube, instructing the client to perform the Valsalva maneuver is essential. This maneuver involves holding the breath and bearing down, which helps prevent air from entering the pleural space during tube removal, reducing the risk of pneumothorax. Instructing the client to lie on their left side, use the incentive spirometer, or cough at regular intervals is not appropriate during the chest tube removal process.

2. Which of the following is an example of a primary prevention strategy in public health?

Correct answer: B

Rationale: The correct answer is B. Vaccination programs are considered a primary prevention strategy in public health because they aim to prevent the occurrence of diseases before they occur. Screening for diabetes (choice A) is more of a secondary prevention strategy that aims to detect and treat the disease early. Emergency response planning (choice C) is more focused on preparedness and response rather than preventing the initial occurrence of health issues. Chronic disease management (choice D) involves treating and controlling diseases that have already developed, making it a tertiary prevention strategy rather than primary.

3. A client learns about pursed-lip breathing. Which statement by the client indicates teaching has been effective?

Correct answer: B

Rationale: The correct technique for pursed-lip breathing involves inhaling slowly through the nose and exhaling slowly through pursed lips. This technique helps improve expiration and reduce air trapping. Breathing in quickly, holding the breath, or breathing in and out through pursed lips does not align with the correct method of pursed-lip breathing.

4. Arrange the three stages of prenatal development in the correct order.

Correct answer: D

Rationale: The correct order of the three stages of prenatal development is germinal stage, embryonic stage, and fetal stage. During the germinal stage, the fertilized egg rapidly divides and implants in the uterine wall. The embryonic stage follows, where major organs and systems begin to develop. Finally, during the fetal stage, the developing organism is known as a fetus and continues to grow and mature. Choice A is incorrect because it has the stages in the wrong order. Choice B is incorrect as it also presents the stages out of order. Choice C is incorrect as it reverses the order of the stages. Therefore, the correct answer is D.

5. What is the recommended method to assess hydration status in infants?

Correct answer: C

Rationale: The correct answer is C: Urine output. Assessing urine output is a recommended method to determine hydration status in infants. Adequate urine output indicates good hydration, while decreased urine output may suggest dehydration. Capillary refill time (Choice A) is more indicative of circulatory status rather than hydration. Skin turgor (Choice B) is a useful assessment in adults but can be less reliable in infants. Checking mucous membranes (Choice D) can provide some information on hydration, but it is not as reliable as assessing urine output in infants.

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