A nurse is providing discharge teaching to a client who had an exacerbation of COPD. The client is prescribed a fluticasone by metered-dose inhaler. Which of the following instructions should the nurse include?

Use fluticasone as needed for shortness of breath.

Limit fluid intake to 1 L per day.

Avoid use of pursed-lip breathing.

Obtain a yearly influenza immunization.

Answer and Explanation

The Correct Answer is D

A. Use fluticasone as needed for shortness of breath: Fluticasone is a corticosteroid used for long-term inflammation control in COPD, not for immediate symptom relief. Short-acting bronchodilators like albuterol are used for acute shortness of breath.

B. Limit fluid intake to 1 L per day: COPD clients benefit from adequate hydration (typically 2-3 L per day) to help thin mucus secretions and improve airway clearance. Restricting fluids can lead to thickened secretions and increased respiratory distress.

C. Avoid use of pursed-lip breathing: Pursed-lip breathing is encouraged for COPD clients to help reduce air trapping, improve oxygenation, and promote more effective exhalation. It is an essential technique for managing dyspnea.

D. Obtain a yearly influenza immunization: COPD clients are at higher risk of complications from respiratory infections. An annual influenza vaccine helps reduce the risk of severe illness and exacerbations, making it a crucial part of COPD management.

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Correct Answer is A

Explanation

A. Glucagon 1 mg IM: Glucagon is used to treat severe hypoglycemia when the client is unconscious, having seizures, or unable to take oral glucose. It stimulates glycogen breakdown in the liver, raising blood glucose levels. IM administration is appropriate for rapid effect in an emergency.

B. Continuous IV infusion of regular insulin: Insulin lowers blood glucose levels, which would worsen hypoglycemia. Administering insulin in this situation is inappropriate and could exacerbate the client’s condition.

C. 10 g of oral glucose gel: Oral glucose is suitable for mild to moderate hypoglycemia in a conscious client. However, since the client is experiencing a seizure, they are unable to swallow safely, making this option unsafe.

D. 1 L bolus of 0.45% sodium chloride over 1 hr: Hypoglycemia is not primarily treated with IV fluids unless the client is severely dehydrated. The priority in this case is to correct the low blood glucose level rather than administering hypotonic fluids.

A. Verify the solution with another RN prior to infusion. B. Monitor serum blood glucose during infusion.. C. Increase the rate of infusion if administration is delayed. D. Infuse 0.9% sodium chloride if the solution is not available. E. Obtain the client's weight daily.

Correct Answer is ["A","B","E"]

Explanation

A. Verify the solution with another RN prior to infusion: TPN is a high-risk therapy that requires verification by two RNs to ensure the correct formulation, preventing medication errors that could lead to severe complications.

B. Monitor serum blood glucose during infusion: TPN contains high concentrations of glucose, increasing the risk of hyperglycemia. Regular blood glucose monitoring helps detect imbalances and allows for timely intervention.

C. Increase the rate of infusion if administration is delayed: Increasing the infusion rate can lead to metabolic complications such as hyperglycemia and fluid overload. If TPN is delayed, the provider should be consulted for adjustments rather than increasing the rate independently.

D. Infuse 0.9% sodium chloride if the solution is not available: If TPN is unavailable, the correct alternative is an infusion of dextrose 10% in water (D10W) to prevent hypoglycemia, not 0.9% sodium chloride, which lacks glucose.

E. Obtain the client's weight daily: Daily weights help monitor fluid balance, nutritional status, and potential complications such as fluid retention or dehydration, ensuring proper TPN management.

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A nurse is providing discharge teaching to a client who had an exacerbation of COPD. The client is prescribed a fluticasone by metered-dose inhaler. Which of the following instructions should the nurse include?

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