A patient with chronic obstructive pulmonary disease (COPD) arrives in the emergency department reporting shortness of breath on minimal exertion. Which assessment finding by the nurse would be most important to report to the health care provider?

The patient is sitting in the tripod position.

The patient’s pulse oximetry shows a 90% O2 saturation.

The patient has bibasilar lung crackles.

The patient’s respiratory rate is 9 breaths/min.

Answer and Explanation

The Correct Answer is D

Choice A reason: Tripod position aids breathing in COPD by stabilizing accessory muscles, a common adaptation. It signals distress but isn’t immediately life-threatening compared to respiratory rate, as it reflects chronic compensation rather than acute decompensation requiring urgent intervention.

Choice B reason: O2 saturation of 90% is low but typical in COPD due to ventilation-perfusion mismatch. It warrants monitoring, yet it’s less critical than respiratory rate, as supplemental oxygen can correct it, and it’s not an immediate danger sign.

Choice C reason: Bibasilar crackles suggest fluid or infection, uncommon in pure COPD exacerbations, which show wheezing. This finding needs attention but is less urgent than respiratory rate, as it may indicate pneumonia rather than immediate respiratory failure.

Choice D reason: Respiratory rate of 9 breaths/min is alarmingly low in COPD, where tachypnea (20-30 breaths/min) is expected during exacerbation. Bradypnea indicates potential respiratory depression or fatigue, risking CO2 retention and hypoxia, necessitating immediate reporting for intervention.

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Correct Answer is ["B","C","D"]

Explanation

Choice A reason: Encouraging fluid intake worsens heart failure by increasing preload and congestion. Restriction (e.g., 2L/day) is standard to prevent overload, as excess volume exacerbates dyspnea and edema in compromised hearts.

Choice B reason: Administering diuretics like furosemide reduces fluid overload, easing heart failure symptoms. It lowers pulmonary pressure and edema by enhancing excretion, a critical action to stabilize patients and improve breathing.

Choice C reason: Monitoring weight and fluid balance tracks retention in heart failure; a 2-3 lb gain signals worsening. It guides therapy adjustments, ensuring effective management of volume status and preventing decompensation.

Choice D reason: Educating on low-sodium diets (<2g/day) prevents fluid retention in heart failure. Sodium draws water into vessels, worsening congestion; this empowers patients to control symptoms and supports long-term stability.

A. Encourage the patient to engage in regular low-impact exercise. B. Advise the patient to limit fluid intake to prevent edema. C. Instruct the patient to wear tight-fitting shoes to improve circulation. D. Recommend strict bed rest to minimize pain.

Correct Answer is A

Explanation

Choice A reason: Low-impact exercise, like walking, enhances collateral circulation in PAD, increasing blood flow to ischemic muscles. It reduces claudication by stimulating angiogenesis and improving endothelial function, a cornerstone of evidence-based management to alleviate symptoms effectively.

Choice B reason: Limiting fluid intake addresses edema, not a primary PAD issue, which involves arterial insufficiency, not venous stasis. This strategy lacks scientific support for claudication relief, as hydration status doesn’t directly influence arterial perfusion.

Choice C reason: Tight shoes restrict circulation, worsening PAD by compressing arteries and exacerbating ischemia. Proper footwear is essential, but constriction contradicts vascular physiology, potentially increasing pain and tissue damage rather than improving blood flow.

Choice D reason: Bed rest reduces activity, promoting stasis and deconditioning in PAD, worsening claudication. Immobility decreases muscle pump action and collateral flow, conflicting with evidence that exercise improves symptoms, making this detrimental to recovery.

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A patient with chronic obstructive pulmonary disease (COPD) arrives in the emergency department reporting shortness of breath on minimal exertion. Which assessment finding by the nurse would be most important to report to the health care provider?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Identify the actions the nurse should take to manage this patient’s heart failure effectively. (Select all that apply)

Correct Answer is ["B","C","D"]

Explanation

A 65-year-old patient with a history of Peripheral Artery Disease (PAD) presents to the clinic with complaints of intermittent claudication in the right leg. Which of the following management strategies should the nurse prioritize to improve the patient’s condition?

Correct Answer is A

Explanation

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Complete the following sentence: Given the patient’s symptoms of dyspnea and fatigue, the nurse anticipates the primary care provider may increase the dose of (medication class) to help reduce fluid overload.

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