A nurse is performing chest percussion on a client who has severe COPD. Which of the following actions should the nurse take?

Place a towel over the area to be percussed.

Ask the client to take shallow, rapid breaths.

Percuss over each area for 10 min.

Maintain client positioning for 45 min.

Answer and Explanation

The Correct Answer is A

A. Place a towel over the area to be percussed: A towel should be placed over the area to be percussed to protect the skin and to reduce discomfort. This is a standard procedure to ensure that the percussion is effective and comfortable for the client.

B. Ask the client to take shallow, rapid breaths: Shallow, rapid breaths should be avoided during chest percussion. The client should take deep, slow breaths to help mobilize secretions and allow for effective lung expansion. Rapid breathing could increase respiratory distress.

C. Percuss over each area for 10 min: Percussion should not be performed for 10 minutes over each area, it is done for 1-2 minutes over each lung field to help loosen mucus and improve drainage. Prolonged percussion could be harmful and unnecessary.

D. Maintain client positioning for 45 min: Typically, positioning is maintained for short periods (usually 10-15 minutes) depending on the area being targeted for percussion. Prolonged positioning may lead to discomfort or other complications.

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Correct Answer is B

Explanation

A. "Restrict your partner's oral fluid intake to 450 mL/day.": Fluid restriction in ESKD should be individualized based on the client’s kidney function and retention. A strict 450 mL/day limit is not universally applicable.

B. "Limit your partner's potassium intake to 60 mEq/L per day.": Potassium intake is typically restricted in ESKD due to the kidneys' reduced ability to excrete it. The appropriate restriction depends on potassium levels, but generally, it’s advised to limit intake to prevent hyperkalemia and related complications.

C. "Help your partner consume foods containing phosphorus.": Phosphorus intake should be restricted in ESKD, as high phosphorus levels can cause complications like bone disease. Consuming phosphorus-rich foods should be avoided to prevent calcium-phosphorus imbalances and calcification.

D. "Encourage foods high in protein for your partner.": Excess protein intake in ESKD can exacerbate kidney function decline and increase waste buildup. Protein intake should be monitored and reduced to minimize the kidneys’ workload and prevent further damage.

A. Excessive urinary output B. Elevated sodium level C. Bounding peripheral pulses D. Hyperactive deep tendon reflexes

Correct Answer is C

Explanation

A. Excessive urinary output: In syndrome of inappropriate antidiuretic hormone (SIADH), there is decreased urinary output, not excessive output. The body retains water due to increased antidiuretic hormone (ADH), leading to fluid retention.

B. Elevated sodium level: Due to excessive water retention and dilution of electrolytes, clients with SIADH typically experience hyponatremia (decreased sodium level), not an elevated sodium level. The retained water dilutes the body's sodium concentration.

C. Bounding peripheral pulses: Bounding peripheral pulses are expected in SIADH due to fluid overload, as the body retains excessive water. This leads to increased blood volume and can cause the peripheral pulses to feel strong or "bounding."

D. Hyperactive deep tendon reflexes: Hyperactive deep tendon reflexes are typically associated with conditions such as hypercalcemia or hyperthyroidism, not SIADH. SIADH is more likely to cause muscle weakness and fatigue due to hyponatremia.

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