Author Question: A patient is breathing rapidly. The nurse's most appropriate response would be to: A. take the ... (Read 73 times)

azncindy619 · **on:** Jul 22, 2018

A patient is breathing rapidly. The nurse's most appropriate response would be to:

A. take the patient's radial pulse.
B. count the patient's respirations.
C. take a measurement of the patient's oxygen saturation level.
D. ask the patient if any situations have contributed to this response.

Question 2

A patient in balanced suspension traction can have the head of the bed raised only 30 degrees. To promote normal elimination, patients need to assume a sitting position to:

A. stimulate the peristaltic movement.
B. contract the thigh muscles used to defecate.
C. strengthen the internal and external sphincters.
D. exert intra-abdominal pressure, which aids in defecation.

kaillie · **Reply #1 on:** Jul 22, 2018

Answer to Question 1

C
The radial pulse indicates cardiac rate. Counting respirations will enable you to assess if this response is normal or abnormal for the patient. A number of conditions will cause both normal and abnormal increase in respiratory rate.

Answer to Question 2

D
Physiological factors critical to bowel function and defecation include normal GI tract function, sensory awareness of rectal distention and rectal contents, voluntary sphincter control, and ade-quate rectal capacity and compliance. Contraction of abdominal muscles at times aids in defeca-tion. When stool reaches the rectum, the internal sphincter relaxes.