An older adult female client is hospitalized with a fractured femur. During a routine nursing assessment, she repeatedly asks the nurse to “speak up” so that she can hear the questions. Which action is best for the nurse to take?

Choice A reason: Clay-colored stool indicates bile duct obstruction, not directly related to esophageal varices in cirrhosis. Varices are dilated veins prone to rupture, and while liver dysfunction affects bile, hematemesis is a more immediate, life-threatening complication, making this choice less critical.

Choice B reason: Hematemesis is critical to monitor, as esophageal varices in cirrhosis are fragile, dilated veins that can rupture, causing massive upper gastrointestinal bleeding. This leads to life-threatening hemorrhage, requiring urgent intervention, making it the priority due to its high mortality risk in portal hypertension.

Choice C reason: Anorexia is common in cirrhosis due to metabolic changes but is not specific to varices. While it affects nutrition, it is less urgent than hematemesis, which indicates variceal bleeding, a medical emergency, making this choice secondary to bleeding risk.

Choice D reason: Brown, foamy urine suggests renal issues, like proteinuria, not directly linked to esophageal varices. Variceal bleeding is a more immediate threat in cirrhosis, as urine changes are unrelated to portal hypertension’s acute complications, making this choice less critical.

Choice A reason: Lying on each side with abdominal breathing may aid relaxation but does not optimize gas exchange in emphysema. Pursed-lip breathing better maintains airway pressure, preventing alveolar collapse, which is critical for improving oxygenation and CO2 elimination in COPD.

Choice B reason: Increasing breathing rate for 30 seconds causes hyperventilation, worsening CO2 retention in emphysema by reducing effective tidal volume. This exhausts respiratory muscles, impairing gas exchange, making it counterproductive compared to pursed-lip breathing, which enhances alveolar ventilation.

Choice C reason: Pursed-lip breathing, inhaling through the nose and exhaling slowly through pursed lips, maintains positive airway pressure, preventing alveolar collapse in emphysema. This improves gas exchange by enhancing oxygenation and CO2 removal, making it the most effective instruction for dyspnea relief.

Choice D reason: Raising hands above the head may stretch the chest but does not address emphysema’s airflow limitation. It can strain respiratory muscles, worsening dyspnea, unlike pursed-lip breathing, which directly improves alveolar ventilation and gas exchange, making this choice ineffective.