1. The nurse is caring for a preoperative patient. The nurse teaches the principles and demonstrates leg

exercises for the patient. The patient is unable to perform leg exercises correctly. What is the nurse’s

best next step?

a. Encourage the patient to practice at a later date.

b. Assess for the presence of anxiety, pain, or fatigue.

c. Ask the patient why exercises are not being done.

d. Evaluate the educational methods used to educate the patient.

ANS: B

If the patient is unable to perform leg exercises, the nurse should look for circumstances that may be impacting

the patient’s ability to learn. In this case, the patient can be anticipating the upcoming surgery and may be

experiencing anxiety. The patient may also be in pain or may be fatigued; both of these can affect the ability to

learn. Evaluation of educational methods may be needed, but in this case, principles and demonstrations are

being utilized. Asking anyone “why” can cause defensiveness and may not help in attaining the answer. The

nurse is aware that the patient is unable to do the exercises. Moving forward without ascertaining that learning

has occurred will not help the patient in meeting goals.

2. Which nursing assessment will indicate the patient is performing diaphragmatic breathing correctly?

Hands placed on the border of the rib cage with fingers extended will

a. touch as the chest wall contracts.

Hands placed on the chest wall with fingers extended will separate as

b. the chest wall contracts.

The patient will feel upward movement of the diaphragm during

c. inspiration.

The patient will feel downward movement of the diaphragm during

d. expiration.

ANS: A

Positioning the hands along the borders of the rib cage allows the patient to feel movement of the chest and

abdomen as the diaphragm descends and the lungs expand. As the patient takes a deep breath and slowly

exhales, the middle fingers will touch while the chest wall contracts. The fingers will separate as the chest wall

expands. The patient will feel normal downward movement of the diaphragm during inspiration and normal

upward movement during expiration.

3. The nurse is caring for a postoperative patient with an abdominal incision. The nurse provides a pillow to

use during coughing. Which activity is the nurse promoting?

a. Pain relief

b. Splinting

c. Distraction

d. Anxiety reduction

ANS: B

Deep breathing and coughing exercises place additional stress on the suture line and cause discomfort.

Splinting incisions with hands and a pillow provides firm support and reduces incisional pull. Providing a

pillow during coughing does not provide distraction or reduce anxiety. Providing a pillow does not provide

pain relief. Coughing can increase anxiety because it can cause pain. Analgesics provide pain relief.

4. The nurse is encouraging a reluctant postoperative patient to deep breathe and cough. Which explanation

can the nurse provide that may encourage the patient to comply?