An older adult client with a long history of chronic obstructive pulmonary disease (COPD) is admitted with progressive shortness of breath and a persistent cough. The client is anxious and is complaining of a dry mouth. Which intervention should the nurse implement?
Administer a prescribed sedative
Assist client to an upright position.
Encourage client to drink water
Apply a high-flow venturi mask.
The Correct Answer is B
A. Administer a prescribed sedative:
Sedatives may depress the respiratory drive, which can be detrimental in a client with respiratory distress. It is not the appropriate intervention in this case.
B. Assist the client to an upright position.
Positioning the client upright helps improve respiratory mechanics by reducing the pressure on the diaphragm and allowing better lung expansion. This position can enhance the efficiency of breathing and alleviate symptoms of breathlessness.
C. Encourage the client to drink water:
While maintaining hydration is important, it may not directly address the immediate respiratory distress. Addressing the respiratory symptoms with an upright position is more crucial at this moment.
D. Apply a high-flow venturi mask:
While oxygen therapy may be necessary for a client with COPD experiencing respiratory distress, the first step is to assist the client to an upright position to improve respiratory mechanics. Applying a high-flow venturi mask may be a subsequent intervention based on the overall assessment, but positioning is the initial priority.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Carcinogens are substances that contain cancerous cells:
This statement is incorrect. Carcinogens are substances that have the potential to cause cancer, but they do not necessarily contain cancerous cells themselves.
B. Substances that change a cell so that it becomes cancerous are potential sources of cancer:
This is the correct answer. Carcinogens are agents that can induce changes in the genetic material of cells, leading to the development of cancer. They can initiate or promote the process of carcinogenesis.
C. Environmental factors such as sunlight and chemicals can cause cancer to spread:
This statement is not accurate. Carcinogens can contribute to the initiation or promotion of cancer, but the spread of cancer (metastasis) involves complex biological processes and is not directly caused by environmental factors.
D. Carcinogens are in the environment and cannot be avoided:
This statement is not accurate. While carcinogens may be present in the environment, efforts can be made to minimize exposure and adopt preventive measures. Avoidance of known carcinogens and the promotion of a healthy lifestyle can contribute to cancer prevention.
Correct Answer is A
Explanation
A. Move the client to a private room, keep the door closed, and initiate droplet precautions:
This is the correct answer. Given the client's symptoms and potential exposure to COVID-19, it is important to take infection control measures. Placing the client in a private room, keeping the door closed, and initiating droplet precautions help prevent the potential spread of the virus.
B. Start an intravenous infusion for antiviral drug to be administered for positive COVID-19 test results:
Antiviral medications are typically prescribed based on confirmed COVID-19 test results and the severity of symptoms. Starting an intravenous infusion at this stage, before test results are available, is premature and not indicated.
C. Counsel family members to monitor for illness symptoms for 2 weeks after last contact with the patient:
While it is important for family members to monitor for symptoms, the immediate concern is the isolation and testing of the symptomatic client. Contact tracing may follow, but infection control measures for the client are the priority.
D. Assist the client to recall everyone possibly exposed since onset of symptoms:
While contact tracing is important, the immediate action is to isolate the client and initiate precautions. Contact tracing can be done as part of a broader public health response but is not the initial step.
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