A home health nurse is visiting a client who has COPD and is receiving oxygen at 2 L/min via nasal cannula.
The client tells the nurse she has been having difficulty breathing.
Which of the following actions is the nurse's priority at this time?

Have the client cough and expectorate secretions.

Instruct the client to use a pursed-lip breathing technique.

Increase the oxygen flow to 3 L/min.

Evaluate the client's respiratory status.

Answer and Explanation

The Correct Answer is D

Choice A rationale:

Having the client cough and expectorate secretions is a reasonable intervention for managing respiratory distress, but it is not the top priority. The nurse should first assess the client's overall respiratory status to determine the severity of the problem.

Choice B rationale:

Instructing the client to use a pursed-lip breathing technique is a helpful strategy to improve breathing in some cases. However, it should not be the top priority when a client is experiencing difficulty breathing. Assessment should come first.

Choice C rationale:

Increasing the oxygen flow to 3 L/min without a proper assessment is not advisable. It's essential to evaluate the client's respiratory status before making any adjustments to the oxygen therapy.

Choice D rationale:

"Evaluate the client's respiratory status" is the correct response. When a client with COPD and oxygen therapy reports difficulty breathing, the nurse's priority is to assess the client's respiratory status. This assessment will help determine the cause of the breathing difficulty and guide appropriate interventions. The nurse should also check the oxygen saturation levels, respiratory rate, and auscultate lung sounds to assess the severity of the issue.

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Correct Answer is A

Explanation

Choice A rationale:

"I can plan to eat rice instead of baked potatoes.”. This choice demonstrates an understanding of dietary sources of potassium. Baked potatoes are a good source of potassium, and the client's willingness to substitute rice for baked potatoes indicates that they are aware of alternative potassium-rich foods. Potassium is essential for various bodily functions, including maintaining proper heart and muscle function. The client's willingness to make a dietary adjustment is a positive sign.

Choice B rationale:

"Adding pecans will be a change I can readily make.”. While pecans are a good source of potassium, this choice does not directly address the client's ability to substitute a potassium-rich food for one they might need to avoid. It focuses on a new addition to their diet rather than a substitution, making it a less relevant response to the teaching.

Choice C rationale:

"I will eat cantaloupe for my morning snack.”. Cantaloupe is indeed a good source of potassium, but this choice does not indicate an understanding of how to substitute potassium-rich foods in their diet. It only mentions adding cantaloupe as a snack without addressing the potential need for replacing other foods high in potassium. Therefore, it does not fully demonstrate comprehension of the teaching.

Choice D rationale:

"I will miss eating yogurt every day for breakfast.”. This choice expresses a sentiment but does not show an understanding of the teaching regarding dietary sources of potassium. It merely states that the client will miss yogurt without providing any insight into their ability to make appropriate dietary choices to maintain adequate potassium intake.

A. Captopril. B. Metoprolol. C. Furosemide. D. Digoxin.

Correct Answer is A

Explanation

The correct answer is A. Captopril.

Choice A: Captopril Captopril is an angiotensin-converting enzyme (ACE) inhibitor used to treat conditions like high blood pressure and heart failure. One of the common side effects of ACE inhibitors is a persistent, non-productive cough. This cough occurs due to the accumulation of bradykinin, a potent peptide that can induce coughing.

Choice B: Metoprolol Metoprolol is a beta-blocker used to treat high blood pressure and heart failure. Common side effects include dizziness, slow or irregular heartbeat, and unusual tiredness or weakness. However, it is not typically associated with a non-productive cough.

Choice C: Furosemide Furosemide is a loop diuretic used to treat fluid retention (edema) in people with congestive heart failure, liver disease, or a kidney disorder. While it can cause side effects like diarrhea, constipation, and loss of appetite, a non-productive cough is not a typical side effect of Furosemide.

Choice D: Digoxin Digoxin is used to treat heart failure and irregular heartbeat. Common side effects include dizziness, slow or irregular heartbeat, and unusual tiredness or weakness. However, a non-productive cough is not a typical side effect of Digoxin.

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A home health nurse is visiting a client who has COPD and is receiving oxygen at 2 L/min via nasal cannula.The client tells the nurse she has been having difficulty breathing.Which of the following actions is the nurse's priority at this time?

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A home health nurse is visiting a client who has COPD and is receiving oxygen at 2 L/min via nasal cannula.
The client tells the nurse she has been having difficulty breathing.
Which of the following actions is the nurse's priority at this time?