Basic Care and Comfort NCLEX Questions with Rationale

NCLEX Basic Care and Comfort Questions

Basic Care and Comfort NCLEX Practice Questions

Question 1. 
The nurse is providing dietary instruction to a client with diabetes who has normal kidney function. Which statement by the client requires intervention by the nurse?
(a) "I should limit cholesterol intake to 200 mg/day."
(b) "I should eat very low or no carbohydrates when possible."
(c) "My protein intake should be 15% to 20% of my daily calories."
(d) "Fiber will improve my carbohydrate metabolism and lower cholesterol."
Answer:
(b) "I should eat very low or no carbohydrates when possible."
table
Rationale: 
Carbohydrates help maintain postmeal glucose levels, and proper carbohydrate intake helps achieve glucose regulation and glycemic control. Balancing cholesterol intake with protein intake follows current ADA dietary recommendations. Fiber also helps stabilize carbohydrate metabolism and lower cholesterol.

Question 2. 
A client with gastroesophageal reflux disease (GERD) is talking to the nurse about ways to manage her condition. Which statement reflects an understanding of management of GERD?
(a) "I can elevate the head of my bed 6 to 12 inches to help prevent nighttime reflux."
(b) "I can eat a large breakfast and smaller meals for lunch and dinner to help me feel better."
(c) "Lying on my left side will promote oxygenation and frequent swallowing to help clear my esophagus."
(d) "I should take liquid antacids to coat my esophagus and buffer acid 2 hours before I eat and 1 hour after meals."
Answer:
(a) "I can elevate the head of my bed 6 to 12 inches to help prevent nighttime reflux."

Rationale:
Elevating the head of the bed with blocks or a large, wedge pillow can prevent reflux. Large meals should be avoided; instead the diet should consist of 4 to 6 small meals throughout the day. Lying on the right side, not the left, helps promote oxygenation and frequent swallowing to help clear the esophagus. Liquid antacids should be taken 1 hour before and 2 to 3 hours after meals.

Question 3.
The nurse is caring for a client who adheres to a lacto-vegetarian diet. Which meal tray would the nurse deliver to the client?
(a) chicken sandwich, brown rice, yogurt, and milk
(b) steamed vegetables with rice and apple slices
(c) scrambled eggs, cottage cheese, dry toast, and milk
(d) baked zucchini, spinach salad with cheese, and yogurt
Answer:
(d) baked zucchini, spinach salad with cheese, and yogurt

Rationale:
Lacto-vegetarians eat milk, cheese, and dairy but no meat, fish, poultry, or eggs. The lacto- ovo-vegetarian includes eggs in the diet; option 3 reflects this diet choice. Vegans eat only plant-based foods and would choose option (b) Option 1 contains poultry and would not fall under vegetarian diet guidelines.

Question 4.
The nurse is caring for a client who just returned from an above-the-knee amputation of the left leg. Which position should the nurse place the client in?
(a) supine, with the affected limb flat on the bed
(b) supine, with a wedge pillow between the thighs
(c) supine, with the affected limb elevated on a pillow
(d) on the left side with the head of the bed at 30 degrees
Answer:
(c) supine, with the affected limb elevated on a pillow

Rationale:
The affected limb is elevated to decrease edema and promote venous return for the first 24 hours. After this time, the client is normally positioned supine with the affected limb flat on the bed to prevent hip contracture. Wedging a pillow between the thighs causes abduction at the hips and can cause contracture. The client would not be placed on the left side due to increased pressure on the operative site, which could cause bleeding and impede blood flow.

Question 5. 
A client has orders for placing a nasogastric tube. In which position should the nurse place the client for insertion?
(a) low Fowler's
(b) high Fowler's
(c) reverse Trendelenburg's
(d) on the side opposite of the nare used for insertion 
Answer:
(b) high Fowler's

Rationale:
A high Fowler's position facilitates insertion of the tube and prevents aspiration should the client vomit. The other positions do not facilitate insertion and greatly increase the risk of pulmonary aspiration.

Question 6.
The nurse is assisting the health care provider performing a liver biopsy on a client. How should the nurse position this client? Select all that apply.
(a) position the client supine with the left upper abdomen exposed
(b) position the client supine with the right upper abdomen exposed
(c) position the client in a low Fowler's with the right upper abdomen exposed
(d) raise the client's right arm and extend it behind the head, over the left shoulder
(e) raise the client's right arm and extend it across the front of the chest touching the left shoulder
Answer:
(b) position the client supine with the right upper abdomen exposed
(d) raise the client's right arm and extend it behind the head, over the left shoulder

Rationale:
Positioning the client supine with the right upper abdomen exposed allows the best access to the right intercostal spaces. Raising the right arm and extending it behind the head opens up the intercostal area and keeps the arm out of the way. The liver is located on the right side; positioning the client with the left upper abdomen exposed does not allow access to the site. The client should be placed supine, never in a low Fowler's or other elevated position. The client's right arm should not be positioned across the front of the chest as this does not provide maximum access to the site. 

Question 7. 
The unit nurse is precepting a nursing student who is assisting a client with a femur fracture onto a fracture bedpan. Which action by the student nurse requires intervention by the unit nurse? Select all that apply.
(a) The student nurse tries to lift the client onto the bedpan.
(b) The student nurse positions the head of the bed between 30 and 45 degrees.
(c) The student nurse places the call light within reach and tells the client she will return shortly.
(d) The student nurse places the bedpan with the shallow end under the buttocks toward the sacrum.
(e) The student nurse places the bedpan with the deeper end under the buttocks toward the sacrum.
Answer:
(a) The student nurse tries to lift the client onto the bedpan.
(e) The student nurse places the bedpan with the deeper end under the buttocks toward the sacrum.

Rationale:
Clients should never be lifted onto a bedpan, as this can cause muscle strain for both the client and nurse. If the client cannot raise up for bedpan placement, the client should be rolled onto the bedpan. The fracture bedpan differs from a regular bedpan in that it is smaller and has a shallow upper end. The shallow end should go under the buttocks, and the deeper end where the handle is should be placed under the upper thighs.

Unless contraindicated, the bed should not be placed flat as this causes the client to hyperextend the back while hips are elevated on the bedpan. Placing the call light within reach and stepping out for a few minutes preserves client privacy and dignity. If the client has not called within 5 minutes, the nurse should check back on the client. A confused client may forget that the bedpan is in place and remain on it too long, which can increase the risk of decubitus and/or skin shear.

Question 8. 
The nurse is caring for a client who just had a laparoscopic appendectomy. The client tells the nurse that she does not want "drugs" for pain management, but prefers alternative therapy and/or complementary therapy. Which is the best response by the nurse?
(a) "I know of some herbs and supplements that you can take to manage the pain."
(b) "Tell me what works for you, and I will see what we can provide for your comfort."
(c) "We use real medicine here in the hospital, so I will bring you hydrocodone for pain when you need it."
(d) "Yoga always relaxes me. I will get you a foam mat from physical therapy so you can practice when you want."
Answer:
(b) "Tell me what works for you, and I will see what we can provide for your comfort."

Rationale:
Asking clients what works for them shows respect for their practices and beliefs. Some low- risk therapies that the client might try include music therapy, meditation, prayer, and relaxation techniques. For mild pain, distraction may be helpful to remove the focus from the pain. Once the nurse knows the client's preferences, the health care provider can be consulted as to which therapies may be ordered. The nurse should not recommend any herbs or supplements for pain. This constitutes practicing medicine without a license. 

Any medication the client takes, including over-the-counter medicines or supplements, must be ordered by the provider. Some herbal mixtures or supplements can be toxic, and there is no consistent standard for such products. The client has had anesthesia for the procedure, therefore increasing the risk of an interaction between anesthesia and an unknown substance. Telling the client that they only use "real" medicine in the hospital shows a lack of respect for the client and her beliefs and is insulting. 

The nurse should not insist on opioids or other medications if the client states that she does not want to take them. While yoga may help relieve stress and pain, a client who is newly post-op will not be able to perform such activities. The nurse is also pushing his own agenda by telling the client what works for him. The focus is on therapies that help the client, not the nurse.

Question 9. 
The nurse is caring for a client with fluid overload who is on strict I's and O's. The nurse understands that which is the best way to ensure accurate I's and O's?
(a) clear any IV pumps and reset to zero for accurate IV fluid intake
(b) ask the client to keep up with how many cups of fluid he drinks at meals
(c) ask the client to report how much urine is in the urinal each time he uses it
(d) tell the client not to ask for any extra water or drinks that are not on the meal tray
Answer:
(a) clear any IV pumps and reset to zero for accurate IV fluid intake

Rationale:
Clearing the pump ensures that IV fluid intake will be accurate. A client on strict I's and O's is not necessarily on fluid restriction, and may receive IV fluids, blood, or antibiotics and other medications. Options 2 and 3 shift responsibility from the nurse to the client, which is not acceptable. The nurse monitors all intake and output. Option 4 is rude and not appropriate; the client may ask for other fluids in between meals.

Question 10.
A client has just returned from a cardiac catheterization with access via the femoral artery. Which position or activity should the nurse anticipate the health care provider will order for this client?
(a) bed rest with bathroom privileges
(b) bed rest with head of bed at 45 degrees
(c) ambulation to prevent blood clot formation
(d) bed rest with head of bed at 30 degrees or less
(e) up to chair with assistance if the client is steady on his feet
Answer:
(d) bed rest with head of bed at 30 degrees or less

Rationale:
In the immediate post-catheterization phase, the client remains on bed rest for 4 to 6 hours with the accessed extremity kept straight until hemostasis is achieved. The client would not have bathroom privileges during this period and should be offered the bedpan or urinal as needed. Keeping the head of the bed at 45 degrees would place too much pressure on the access site. Ambulation to prevent clot formation occurs only after bed rest time is up and hemostasis is achieved. Frequent inspection of the femoral site for hematoma, oozing, or frank bleeding is a priority throughout the recovery process.

Question 11. 
Mix and Match: Match the nursing intervention to the pulmonary disorder

Pulmonary Disorder	Nursing Intervention
1. emphysema	hydration of at least 2l/day to thin and loosen pulmonary secretions
2. asthma	teach controlled coughing
3. cystic Fibrosis	prevent spread of infection to others
4. chronic bronchitis	identify and minimize pulmonary irritants
5. pneumonia	teach diaphragmatic, pursed-lip breathing
6. influenza	provide frequent mouth care to reduce chances of infection from mucus being present
7. pulmonary embolus	monitor drainage from chest tube system
8. pneumothorax	monitor for right-sided heart failure

Answer:

Pulmonary Disorder	teach diaphragmatic, pursed-lip breathing
1. emphysema	identify and minimize pulmonary irritants
2. asthma	provide frequent mouth care to reduce chances of infection from mucus being present
3. cystic Fibrosis	teach controlled coughing
4. chronic bronchitis	hydration of at least 2l/day to thin and loosen pulmonary secretions
5. pneumonia	prevent spread of infection to others
6. influenza	provide frequent mouth care to reduce chances of infection from mucus being present
7. pulmonary embolus	monitor for right-sided heart failure
8. pneumothorax	monitor drainage from chest tube system

Question 12.
Mix and Match: Match the nursing intervention to the endocrine disorder.

Endocrine Disorder	Nursing Intervention
1. tumor posterior pituitary gland	measure urine specific gravity
2. hypoparathyroidism	monitor airway
3. Addison's disease	instruct on high-sodium, low-potassium diet
4. Cushing's disease	instruct on low-sodium, high-potassium diet

Answer:

Endocrine Disorder	Nursing Intervention
1. tumor posterior pituitary gland	instruct on high-sodium, low-potassium diet
2. hypoparathyroidism	instruct on low-sodium, high-potassium diet
3. Addison's disease	measure urine specific gravity
4. Cushing's disease	monitor airway

Question 13.
Mix and Match: Match the nursing intervention to the location of injury to the portion of the client's brain.

Injured Brain Area	Nursing Intervention
1. frontal lobe	assist with ADI due to visual disturbances
2. temporal lobe	assist with walking
3. occipital lobe	monitor vital signs
4. brain stem	give simple instructions; reorient as needed
5. parietal lobe	provide simple, one-step instructions
6. cerebellum	speak clearly due to impaired hearing

Answer:

Injured Brain Area	Nursing Intervention
1. frontal lobe	give simple instructions; reorient as needed
2. temporal lobe	speak clearly due to impaired hearing
3. occipital lobe	assist with ADI due to visual disturbances
4. brain stem	monitor vital signs
5. parietal lobe	provide simple, one-step instructions
6. cerebellum	assist with walking

Question 14.
The nurse is preparing to receive an 18-month-old client from surgery who had repair of a congenital hip deformity. What type of traction does the nurse anticipate setting up for the client?
Answer:
40. Correct response: Bryant's traction
Rationale: Bryant's traction is used following corrective surgery to repair congenital hip deformities. It involves wrapping the child's legs with moleskin tape and an adhesive elastic bandage which is attached to a series of ropes and weights. The tension helps keep the end of the femur in the hip socket during the healing process.

Question 15. 
The nurse is caring for a client whose lab results show triglycerides of 380 and cholesterol level of 240. Which foods would the nurse educate the client about including in his diet when he is discharged? Select' all that apply.
(a) wheat toast with sugar-free jelly
(b) grilled salmon seasoned with herbs
(c) an egg-white omelet with vegetables
(d) natural honey from a local farmer's market
(e) plain grilled steak prepared with pepper only
Answer:
(b) grilled salmon seasoned with herbs
(c) an egg-white omelet with vegetables

Rationale:
Salmon is a cold-water fish that is rich in omega-3 fatty acids, a good fat that can help lower triglycerides. Grilling eliminates the need for oils or butter, which are high in saturated fat. Herbs offer a very low-calorie way to add flavor to grilled fish. An egg-white omelet eliminates the yolks, which contain the bulk of fat, and vegetables add flavor and nutrients. Animal-based foods are naturally higher in fat; therefore, vegetables such as spinach or red peppers are a better choice than cheese.

Wheat toast is not a good choice since it is high in carbohydrates; too many carbohydrates convert into sugar which raises triglycerides. Although the jelly is sugar free, the high amount of carbohydrates in the whole wheat bread make it a poor choice. Natural honey is still very high in sugar, which should be avoided when trying to * lower triglyceride levels.

Plain grilled steak is not a good choice as it is an animal-based product that is high in fat. A four-ounce serving of sirloin contains about 16 grams of fat, 6 grams of which is saturated. The average person, especially a male, tends to eat far larger servings, which exponentially increases the amount of fat. Skinless poultry is a lower fat choice.

Question 16.
The nurse is preparing to discharge a client who was treated for tuberculosis. Which guidelines for home management should the nurse include in his discharge teaching? Select all that apply.
(a) The client may resume his normal activities.
(b) The family should maintain respiratory isolation at home.
(c) The medication regimen should be followed diligently as prescribed.
(d) The client may return to work when three sputum cultures are negative.
(e) The nurse should educate the client about the medication and possible side effects and their management.
Answer:
(c) The medication regimen should be followed diligently as prescribed.
(d) The client may return to work when three sputum cultures are negative.
(e) The nurse should educate the client about the medication and possible side effects and their management.

Rationale:
The medication regimen for tuberculosis may last up to 12 months, depending on the medications. Strict adherence is important to prevent a relapse. The client may return to most jobs after three sputum cultures are negative. Teaching the client about possible side effects and management of medication helps ensure compliance with treatment. The client should return to his previous activity level gradually, following the health care provider's recommendations. There is no need for the family to maintain respiratory isolation at home since they have already been exposed.

Question 17. 
The nurse is discharging a client who was prescribed prednisone. The nurse tells the client that one of the side effects may be impaired sleep. The client says, "I already have a hard time sleeping. What can I do to help with that?" Which recommendations should the nurse make?
Select all that apply.
(a) avoid alcohol late in the evening
(b) keep the bedroom dark and quiet
(c) maintain the same consistent sleep schedule
(d) eat a large, heavy meal at dinner to help promote sleep
(e) read or do another quiet, noncomputer activity before bed
(f) do a vigorous exercise routine after work to help him become tired 
Answer:
(a) avoid alcohol late in the evening
(b) keep the bedroom dark and quiet
(c) maintain the same consistent sleep schedule
(e) read or do another quiet, noncomputer activity before bed

Rationale:
The nurse will educate the client on good sleep hygiene. Keeping the bedroom dark and quiet helps promote sleep. Rooms that are too light due to outside lights should be fitted with dark shades or curtains. Going to bed and getting up at the same time helps the body maintain a circadian rhythm. Sleeping in late on weekends can disrupt weekday sleep. Reading and other quiet activities help the client relax and prepare for sleep.

Computers and TVs emit blue light, which stimulates the brain to stay alert. Despite common belief, alcohol does not help with sleep. It may make it easier to fall asleep initially, but later disrupts REM sleep, making it easier to wake. A heavy meal before bed stimulates the metabolism and can cause discomfort, leading to difficulty sleeping. Vigorous activity close to bedtime will stimulate the body, making sleep harder.

Question 18. 
The nurse is caring for a client who has a nasogastric tube for medication administration and tube feedings. How should the nurse care for the tube during her shift? Select all that apply.
(a) flush tube every 4 hours with hot water to maintain patency
(b) allow the feeding and tubing to hang until empty, up to 48 hours
(c) maintain the head of bed in a high-Fowler's position during feedings
(d) check residuals and replace them unless the amount is greater than 300 mL
(e) check under the adhesive tape on the nose daily to assess for skin breakdown
(f) assess the bowel sounds before feeding, and feed at half the rate if bowel sounds are absent
Answer:
(c) maintain the head of bed in a high-Fowler's position during feedings
(e) check under the adhesive tape on the nose daily to assess for skin breakdown

Rationale:
In order to prevent aspiration, the head of the bed should be in a high-Fowler's position whenever feedings are infusing. The tape on the nose should be removed daily and the skin assessed for breakdown; the tape should then be replaced, using care not to move the tube. The tube should be flushed every 4 hours using tepid water, not hot. Using hot water can cause discomfort and possibly burn the client.

Tubing and feedings must be changed every 24 hours, even if there is still feeding left in order to prevent bacterial growth. Residuals should be replaced unless the amount is greater than 250 mL. In that case, discard the extra and consider slowing the feeding rate using the health care provider's guidelines. If no bowel sounds are present, hold the feeding and contact the health care provider.

Question 19. 
The nurse is teaching a group of nursing students about proper client positioning. Which statement by a student nurse indicates an understanding of proper positioning?
(a) A client receiving an enema should be placed on the right side in the Sims' position.
(b) A client with a below-the-knee amputation should be positioned with the affected limb elevated at a 45-degree angle.
(c) Clients with pulmonary edema should be positioned upright with the legs dangling over the side of the bed.
(d) Clients with a craniotomy should be positioned with the head of bed at a 20-degree angle with the head in a neutral, midline position.
Answer:
(c) Clients with pulmonary edema should be positioned upright with the legs dangling over the side of the bed.

Rationale:
Clients with pulmonary edema should be positioned upright with the legs dangling over the side of the bed to decrease venous return. Clients receiving an enema should be positioned on the left side in the Sims' position to allow the gravity flow of the solution to follow the direction of the colon. Client with lower limb amputations should have the affected limb supported but not elevated in order to prevent flexion contractures. Clients with a craniotomy should be positioned with the head of bed at a 30- to 45-degree angle to promote venous drainage from the head.

Question 20.
The nurse is caring for a client with deep vein thrombosis (DVT). Which should be included in the plan of care?
(a) bed rest with the affected extremity elevated
(b) bed rest with the bed in reverse Trendelenburg
(c) walking slowly in the hall with assistance to prevent pneumonia
(d) sitting up in the chair for all meals and during visitation time
Answer:
(a) bed rest with the affected extremity elevated

Rationale:
Clients with DVT should be on bed rest to prevent movement of the DVT and pressure changes that occur with walking and other weight-bearing activities. The affected extremity should be elevated. Placing the bed in reverse Trendelenburg will increase pressure on the affected extremity. Walking is contraindicated for clients with DVT; while preventing hospital-acquired pneumonia is important, client safety takes priority over pneumonia prevention at this time. The client may still use an incentive spirometer and practice coughing and deep breathing to clear the lungs without ambulating. Sitting up in a chair is also contraindicated until the DVT has resolved and the health care provider has prescribed activity for the client.

Question 21. 
The nurse is assessing a six-month-old infant at the clinic. When the nurse strokes from the heel of the foot upward toward the ball, the infant exhibits no movement. Which action is the priority for the nurse?
(a) take the infant's vital signs
(b) order a neurology consult
(c) examine the infant's nose and ears
(d) ask how much formula the infant consumes daily
Answer:
(b) order a neurology consult

Rationale:
The infant is failing to exhibit the Plantar reflex, or Babinski's sign. This is a normal reflex present until 1 year of age. Lack of the reflex indicates the need for further neurological assessment by the health care provider. Taking the infant's vital signs is a necessary part of every visit but is not the priority here. Examining the nose and ears is not indicated at this time and is not as urgent as determining if the infant has neurological deficits. Determining how well the infant feeds is important to track, but is not the primary concern for this client.

Question 22. 
The nurse is caring for a client with COPD who complains of poor quality of sleep. Which question should the nurse ask next?
(a) "Does your partner snore heavily?"
(b) "Do you get exercise during the day?"
(c) "How many pillows do you sleep on?"
(d) "Do you eat large meals right before bed?"
Answer:
(c) "How many pillows do you sleep on?"

Rationale:
Asking the client how many pillows she sleeps on evaluates the client for orthopnea, which is shortness of breath caused by lying down. The more pillows the client requires, the worse the orthopnea. This provides important information to the health care provider. Snoring partners, the amount of daily exercise the client gets, and eating heavy meals before bed also affect sleep; however, in the client with COPD, determining the extent of orthopnea will best help prescribe treatments.

Question 23. 
The nurse is teaching infant CPR to a group of newly graduated nurses hired to work in the labor and delivery unit. The nurse understands that proper technique with infants includes which action? Select all that apply.
(a) The femoral artery is checked for a pulse following each cycle of CPR.
(b) Chest compression depth should be approximately 1.5 inches, or 4 cm.
(c) A single rescuer should use three fingers on the dominant hand to do compressions.
(d) Rest the infant facedown on the forearm with the hand supporting the head and jaw.
(e) If arrest is witnessed the emergency response system should be activated before beginning CPR.
Answer:
(b) Chest compression depth should be approximately (a)5 inches, or 4 cm.
(e) If arrest is witnessed the emergency response system should be activated before beginning CPR.

Rationale:
CPR on infants less than 1 year of age includes a chest compression depth of approximately (a)5 inches, or 4 cm. A witnessed arrest calls for activating the emergency response system before initiating CPR. An automated external defibrillator should be retrieved before starting CPR. The pulse checkpoint on an infant is the brachial artery. A single rescuer should use two fingers for compression, regardless of which hand is dominant. Resting the infant facedown on the forearm is proper positioning for performing the Heimlich maneuver. CPR is performed with the infant lying face up and flat on a firm surface.

Question 24. 
The nurse is caring for a comatose client with a Salem sump tube. Which action by the nurse is correct regarding care of this client?
(a) clamp the air vent during tube feedings
(b) place the client on the left side in a high-Fowler's position
(c) assess the position of the Salem sump before each feeding
(d) infuse bolus feedings with a pump or by gently plunging into the stomach
Answer:
(c) assess the position of the Salem sump before each feeding

Rationale:
The Salem sump's position should be checked before each feeding by aspirating gastric content and measuring pH (should be 3.5 or less). Administering feedings through an improperly positioned tube may cause aspiration. The air vent should not be clamped and should be kept above stomach level. The comatose client should be placed on the right side in the high-Fowler's position. Bolus feedings should be infused via a pump or allowed to flow by gravity. Feedings should never be forcibly plunged into the client.

Question 25. 
The nurse is teaching a client diagnosed with gastroesophageal ref ux disease (GERD) about dietary measures to manage symptoms. Which food does the nurse advise the client to avoid?
(a) bananas
(b) tomatoes
(c) white bread
(d) grilled salmon
(e) steel-cut oatmeal
Answer:
(b) tomatoes

Rationale:
The nurse should instruct the client to eat a low-fat, high-fiber diet, avoiding acidic foods. Tomatoes are highly acidic and consumption of tomatoes or tomato-based sauces can worsen the symptoms of GERD. Bananas are low in fat and acid and contain fiber. White bread does not contain acid and has fiber. Grilled salmon is a low-fat choice that avoids fried foods, which are high in fat and irritating to clients with GERD. Steel-cut oatmeal is a low-fat, high-fiber option.

Question 26. 
The nurse is caring for a client with sternal wires following a coronary artery bypass graft (CABG). The client complains of severe pain when coughing and deep breathing. What nonpharmacological measures can the nurse take to increase client comfort? Select all that apply.
(a) apply hot packs to the sternum
(b) give morphine PRN for pain before client coughs
(c) suggest using audio books or relaxing music as a distraction
(d) teach the client how to use a pillow to splint the chest when coughing
(e) encourage the client to engage in prayer, meditation, or other activities
(f) properly position the head of the bed to minimize pressure on the sternum 
Answer:
(c) suggest using audio books or relaxing music as a distraction
(d) teach the client how to use a pillow to splint the chest when coughing
(e) encourage the client to engage in prayer, meditation, or other activities
(f) properly position the head of the bed to minimize pressure on the sternum 

Rationale:
Listening to audio books or music can take the client's focus off the pain. Distraction is a useful tool to shift focus away from pain and also includes music therapy and art therapy when appropriate for the client. Splinting the sternum when coughing is one of the most important things post-CABG clients can do to increase their comfort. If the client engages in prayer, meditation, or other rituals at home, he should be encouraged to continue those practices in the hospital. This is respectful to the client and his beliefs and/or culture and allows him to have some measure of control on maintaining normal routines.

The bed should be positioned so as to not increase pressure on the sternum. Hot or cold packs should not be used on the sternum, as this area is a fresh post-op site and should be kept clean. Also, the packs may place pressure on the sternum and cause more discomfort. Warm, not hot, heat packs may be used on the back to relieve aches from bed positioning if approved by the health care provider. Morphine is a pharmacological method of pain relief.