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."
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Copy of the client's advance directives: While advance directives are important documents, they are typically filed with the medical record, not specifically included in postmortem documentation. The focus for postmortem documentation is on the body and relevant events surrounding the death.
B. Cause of the client's death.: The cause of death is typically recorded in the official death certificate, which is not part of postmortem nursing documentation. The nurse should not make a diagnosis about the cause of death but may note any relevant findings.
C. Last set of the client's vital signs: Vital signs taken at the time of death may be noted as part of the clinical documentation, but they are not specifically part of postmortem documentation. The postmortem documentation should focus on observations regarding the body and its condition.
D. Location of the identification tag on the client’s body: The nurse should document the location of identification tags on the body to ensure proper identification and to prevent confusion or errors in postmortem care. This is an important detail in postmortem documentation.
Correct Answer is B
Explanation
A. Ringing in the ears (tinnitus) is incorrect. Tinnitus is not a common adverse effect of propranolol. This symptom is more commonly associated with ototoxic medications, such as certain antibiotics or diuretics.
B. Bradycardia is correct. Propranolol is a beta-blocker that reduces heart rate and blood pressure by blocking beta-adrenergic receptors. One of its primary adverse effects is bradycardia (slow heart rate., which can lead to dizziness, fatigue, or hypotension.
C. Hypertension is incorrect. Propranolol is used to treat hypertension, not cause it. By reducing cardiac output and suppressing sympathetic nervous system activity, propranolol generally lowers blood pressure.
D. Headache is incorrect. While some clients might experience headaches due to changes in blood pressure, headache is not a primary adverse effect of propranolol.
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