223) Answer

B. B. With 15 minute intervals, the nurse begins to position patient into high-fowler’s, then instructs her to dangle her feet at the bedside, after this, she assists her to move from the bed to the chair and then, walk with her around the room.

Rationale

•Early walking after surgery prevents the development of complications. The nurse facilitates proper ambulation when she instructs the patient to perform leg exercises while in bed and positions her to high-Fowlers.

•Then, the patient is instructed to dangle her feet at the bedside. The patient may feel dizzy, nauseated, or faint so it must be performed slowly and with long intervals in between. Then, the patient is moved from the bed to the chair and should be assisted to walk around the room.

•Other options show inappropriate ambulation because the procedure was done too quickly and non-systematically.

222) Answer

B. Avoiding contact with people who have upper respiratory infections

Rationale

•Acute otitis media generally follows a respiratory infection, it is important to avoid contact with people having upper respiratory infections.

•Inflammation of the middle ear is the most prevalent disease of childhood after respiratory infections.

•There is a higher incidence of acute otitis media in formula-fed infants than those who are breast-fed because of the more slanted position that formula-fed infants are held in while feeding. This allows milk to enter the Eustachian tube.

•Most cases of acute otitis media are caused by bacteria and treated with antibiotics such as amoxicillin. If the infection is viral, antivirals are reserved for severe cases only.