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A client diagnosed with chronic obstructive pulmonary disease (COPD) is given a new prescription for tiotropium via an inhalation device.
Which statement indicates that the client understands the instructions for using this medication?

"If I have sudden shortness of breath, I will use this inhaler."

"When I cough up sputum, the secretions should be less thick."

"I will use my other inhaler in between uses."

"I should use this medication in its handihaler every day."

Answer and Explanation

The Correct Answer is D

Choice A rationale:

Tiotropium is a long-acting bronchodilator, not a rescue inhaler for sudden shortness of breath.

It takes several hours to reach its full effect and is not designed to provide immediate relief during acute symptoms.

Using tiotropium for sudden shortness of breath could delay the use of a more appropriate rescue medication, potentially worsening the situation.

Choice B rationale:

While tiotropium can help reduce mucus production and make secretions easier to clear, this is not its primary mechanism of action.

The client's statement focuses on a potential side effect rather than demonstrating a clear understanding of the medication's intended purpose.

Choice C rationale:

The frequency of inhaler use depends on the specific medications prescribed. Some inhalers are used daily, while others are used only as needed for symptoms.

It's essential to follow the healthcare provider's instructions for each inhaler to ensure proper use and avoid potential drug interactions.

Choice D rationale:

This statement correctly reflects the appropriate use of tiotropium.

It's typically taken once daily via a handihaler device to maintain open airways and prevent COPD symptoms. Regular daily use is crucial for optimal effectiveness.

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Correct Answer is ["B","C"]

Explanation

Choice B rationale:

Gravity Facilitates Drainage:

Positioning the patient strategically utilizes gravity to encourage the flow of fluids and secretions away from the surgical site. This aids in preventing fluid accumulation and potential infection.

Reduces Pressure on Surgical Site:

Certain positions can minimize pressure on the incision and internal organs, promoting healing and reducing discomfort.

This is particularly important for patients with comorbidities like hypertension and heart failure, as they may have impaired wound healing and be more susceptible to respiratory complications.

Enhances Respiratory Function:

Specific positions can improve lung expansion and ventilation, which is essential for patients with a history of heart failure or respiratory issues.

This helps prevent atelectasis (collapsed lung areas) and pneumonia, which are common postoperative risks.

Common Post-Cholecystectomy Positions:

Semi-Fowler's Position:

The head of the bed is elevated 30-45 degrees, with knees slightly bent.

This position eases breathing, reduces pressure on the incision, and promotes drainage of fluids. Right Side-Lying Position:

The patient lies on their right side with a pillow between their knees.

This position encourages drainage from the liver and gallbladder, aiding in bile flow. Left Side-Lying Position:

The patient lies on their left side with a pillow between their knees.

This position promotes drainage from the stomach and pancreas, assisting in digestion. Supine Position:

The patient lies flat on their back with a pillow under their knees.

This position may be used for short periods, but prolonged supine positioning can increase pressure on the incision and lungs. High Fowler's Position:

The head of the bed is elevated 60-90 degrees, with knees slightly bent.

This position is often used for patients with respiratory issues or difficulty breathing, as it improves lung expansion.

Choice C rationale:

Performing drainage immediately after meals aids in efficient removal of bile and gastric secretions, preventing complications such as:

Bile Reflux:

Delayed drainage can cause bile to back up into the stomach, leading to nausea, vomiting, and discomfort. Infection:

Accumulation of fluids in the surgical site can increase the risk of bacterial growth and infection. Pancreatitis:

In rare cases, delayed drainage can cause inflammation of the pancreas due to obstruction of the pancreatic duct.

I'll address the rationales for choices A and D in the following sections.

Correct Answer is B

Explanation

Choice A rationale:

While ABGs can provide valuable information about a patient's respiratory status, they are not routinely required prior to postural drainage in patients with COPD.

ABGs might be considered if the patient is experiencing acute respiratory distress or if there are concerns about their oxygenation or ventilation status.

However, in the absence of such concerns, obtaining ABGs would not be necessary and could potentially cause discomfort or anxiety for the patient.

Choice C rationale:

Performing postural drainage immediately after meals is not recommended for patients with COPD.

This is because eating can cause a feeling of fullness in the stomach, which can make it difficult for the patient to breathe deeply and effectively during the procedure.

Additionally, there is a risk of aspiration if the patient were to vomit during or after postural drainage.

It is generally recommended to perform postural drainage at least 1-2 hours after meals to reduce these risks.

Choice D rationale:

Instructing the patient to breathe shallow and fast is not appropriate for postural drainage.

The goal of postural drainage is to help the patient mobilize and expectorate secretions from the lungs.

This is best achieved by encouraging the patient to breathe deeply and slowly, which helps to open up the airways and promote mucus clearance.

Shallow, rapid breathing can actually make it more difficult to clear secretions and can lead to increased shortness of breath.

Choice B rationale:

Explaining that the patient may be placed in five positions is the most appropriate approach for postural drainage in a patient with COPD.

This is because different positions help to drain different areas of the lungs. The five positions typically used for postural drainage are:

Head down position (to drain the lower lobes)

Prone position (to drain the posterior segments of the lungs)

Right lateral position (to drain the right middle lobe and right lower lobe) Left lateral position (to drain the left lower lobe)

Sitting upright position (to drain the upper lobes)

By placing the patient in these different positions, the nurse can help to ensure that all areas of the lungs are drained effectively.

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A client diagnosed with chronic obstructive pulmonary disease (COPD) is given a new prescription for tiotropium via an inhalation device.Which statement indicates that the client understands the instructions for using this medication?

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Naxlex Comprehensive Predictor Exams

Correct Answer is ["B","C"]

Explanation

When performing postural drainage on a patient with chronic obstructive pulmonary disease (COPD), which approach should the nurse use?

Correct Answer is B

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A client diagnosed with chronic obstructive pulmonary disease (COPD) is given a new prescription for tiotropium via an inhalation device.
Which statement indicates that the client understands the instructions for using this medication?