Which nursing intervention will prevent respiratory complications in the client?

I have a question, please answer this test question:

A nurse is caring for an older immobilized client. Which nursing intervention will prevent respiratory complications in the client?

A. Monitoring vital signs

B. Decreasing fluid intake

C. Changing the client's position every 2 hours

D. Instructing the client to bear down every hour and hold the breath.

Which letter is correct?

Thanks you for your reply

I WOULD put C - but I'm a student also and dont really know....i know D isn't correct at all...and you wouldn't want to decrease there fluid intake....and monitoring v/s isnt a accurate way to prevent respiratory complications....

A nurse is caring for an older immobilized client. Which nursing intervention will prevent respiratory complications in the client?

A. Monitoring vital signs

B. Decreasing fluid intake

C. Changing the client's position every 2 hours

D. Instructing the client to bear down every hour and hold the breath.

I would say it is "C". Monitoring VS is assessment. Decreasing fluid intake is not what you want to do, perhaps if they had said the pt was in CHF, it might be an appropriate answer. Changing position will help mobilize secretions, preventing pneumonia. "D" would be a good answer if it said to "instruct the client to deep breathe and cough, or use an incentive spirometer qh". Think TURN, COUGH, DEEP BREATHE. Hope that helps.

my assessment of question

i have a question, please answer this test question:

a nurse is caring for an older immobilized client. which nursing intervention will prevent respiratory complications in the client?

a. monitoring vital signs

will spot a change in condition, but will not prevent complications

b. decreasing fluid intake

can thicken secretions, decrease pulmonary hygiene effectiveness, and increase risk of infection

c. changing the client's position every 2 hours

will help to move secretions by gravity and encourage cough and deep breathing

d. instructing the client to bear down every hour and hold the breath.

valsava manuver,

which letter is correct?

thanks you for your reply

c