A nurse is reinforcing discharge teaching with a client who has COPD and reports problems with maintaining adequate nutrition. Which of the following instructions should the nurse include?

"Self-administer oxygen through your nasal cannula at 6 milliliters per minute during meals."

"Drink at least 240 milliliters of water during each meal."

"Perform pulmonary hygiene 1 hour before meals."

"Lie down for 30 minutes after eating."

Answer and Explanation

The Correct Answer is C

A. "Self-administer oxygen through your nasal cannula at 6 milliliters per minute during meals." is incorrect. Oxygen should not typically be increased during meals unless specifically prescribed by the provider. If the client has difficulty eating due to breathlessness, a more individualized plan is needed.

B. "Drink at least 240 milliliters of water during each meal." is incorrect. Clients with COPD may have difficulty breathing when consuming large amounts of fluids during meals. Overhydration could also worsen fluid retention in some cases. The amount of fluid should be tailored to the client’s needs and prescribed by the healthcare provider.

C. "Perform pulmonary hygiene 1 hour before meals." is correct. Pulmonary hygiene (such as postural drainage, coughing techniques, and deep breathing exercises) should be performed before meals to clear the airways and improve the ability to breathe while eating, preventing aspiration and difficulty breathing.

D. "Lie down for 30 minutes after eating." is incorrect. Lying down after eating can increase the risk of aspiration, especially in clients with COPD who may already have a compromised respiratory system. The client should be advised to remain upright after meals to prevent reflux and aspiration.

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Correct Answer is A

Explanation

A. The client develops chest pain each time he talks about his partner is an indication of complicated grief. The client’s experience of intense, physical symptoms like chest pain when discussing their partner suggests that the grief process may not be progressing and could indicate unresolved or complicated grief.

B. The client keeps a framed picture of his partner on the wall is a normal expression of grief. Keeping a picture of a lost loved one is common and doesn’t necessarily indicate complicated grief. It can be part of the natural grieving process.

C. The client reports he has no interest in dating is not necessarily a sign of complicated grief. It's common for people grieving to not have an interest in dating or forming new romantic relationships immediately after the loss, but it does not suggest a problem unless the client expresses prolonged avoidance of all social interaction.

D. The client attends a grief support group twice each month is a positive coping mechanism. Attending support groups shows the client is actively engaging with the grieving process and seeking support, which is part of healthy adjustment after a loss.

A. Apply rubber-soled slippers before ambulation. B. Determine the client's ability to use the call light. C. Create a schedule with an assistive personnel to do hourly rounding for the client. D. Move the bedside table with the client's personal items close to the bed.

Correct Answer is B

Explanation

A. "Apply rubber-soled slippers before ambulation.": This is important for safety, but it is not the first step in fall prevention. The client needs to be able to call for assistance if needed before moving around.

B. "Determine the client's ability to use the call light.": This should be the first step. Ensuring that the client can easily use the call light in case they need help is a foundational fall prevention strategy. It is essential for maintaining the client’s safety and enabling them to request assistance when needed.

C. "Create a schedule with an assistive personnel to do hourly rounding for the client.": Hourly rounding is an important fall prevention measure, but it should follow initial steps such as ensuring the client can call for help. It can be implemented after determining how the client will communicate needs.

D. "Move the bedside table with the client's personal items close to the bed.": This is a helpful precaution, as it reduces the need for the client to reach or stand to access their belongings. However, the most critical initial step is ensuring the client can safely summon help if needed.

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A nurse is reinforcing discharge teaching with a client who has COPD and reports problems with maintaining adequate nutrition. Which of the following instructions should the nurse include?

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