A nurse is initiating a plan of care for a client who has COPD. Which of the following interventions should the nurse include?
Request a prescription for an antibiotic.
Educate the client on pursed-lip breathing.
Place the client on airborne precautions.
Initiate oxygen therapy for SpO₂ of 92%.
The Correct Answer is B
Choice A Reason
Request a prescription for an antibiotic. This intervention is not typically included in the standard care plan for all COPD patients. Antibiotics are generally reserved for cases of acute exacerbations of COPD (AECOPD) with signs of bacterial infection, such as increased dyspnea, increased sputum purulence, and increased sputum volume. Routine use of antibiotics without these signs is not recommended.
Choice B Reason
Educate the client on pursed-lip breathing. This is the correct intervention. Pursed-lip breathing is a technique that helps improve ventilation, release trapped air in the lungs, and reduce the work of breathing. It is particularly beneficial for patients with COPD as it helps them manage shortness of breath and improve their breathing efficiency.
Choice C Reason
Place the client on airborne precautions. This intervention is incorrect. COPD is not an infectious disease that requires airborne precautions. Airborne precautions are used for diseases that are transmitted through the air, such as tuberculosis. COPD management focuses on improving lung function and preventing exacerbations.
Choice D Reason
Initiate oxygen therapy for SpO₂ of 92%. This intervention is partially correct but needs clarification. Oxygen therapy is typically initiated for COPD patients with chronic hypoxemia, usually when SpO₂ is less than 88-90%. An SpO₂ of 92% may not necessarily require oxygen therapy unless the patient is experiencing significant symptoms or has other comorbid conditions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A Reason
The client reports relief from pain when lying in the prone position. This statement is incorrect. Clients with a herniated lumbar disc typically find relief from pain when lying on their back with their knees bent or in a fetal position. Lying prone can sometimes exacerbate the pain.
Choice B Reason
The client reports that their low-back pain radiates upward toward one scapula. This statement is incorrect. Pain from a herniated lumbar disc usually radiates downward into the buttocks, legs, and sometimes the feet, not upward toward the scapula.
Choice C Reason
The client reports tingling and a burning sensation in one foot. This is the correct finding. A herniated lumbar disc can compress spinal nerves, leading to symptoms such as tingling, numbness, and a burning sensation in the legs and feet.
Choice D Reason
The client reports decreased pain when the affected leg is raised. This statement is incorrect. Raising the affected leg often increases pain due to the stretching of the sciatic nerve, which can be compressed by the herniated disc.
Correct Answer is C
Explanation
Choice A Reason
Lemonade is not suitable for a client with acute gastritis. Lemonade is acidic and can irritate the stomach lining, potentially worsening the symptoms of gastritis. It is important to avoid acidic foods and beverages to prevent further irritation.
Choice B Reason
Tomato soup is also not recommended for a client with acute gastritis. Tomatoes are acidic and can exacerbate gastritis symptoms. Foods that are low in acidity are better choices for individuals with this condition.
Choice C Reason
Gelatin is the correct choice. It is bland, non-acidic, and easy to digest, making it suitable for someone recovering from acute gastritis. Gelatin can help soothe the stomach lining without causing irritation.
Choice D Reason
Black coffee should be avoided by clients with acute gastritis. Coffee is acidic and can irritate the stomach lining, leading to increased discomfort and symptoms. Caffeine can also stimulate acid production, which is not ideal for someone with gastritis.
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