Exhibits

A nurse is reviewing the medical record of a client who has COPD. The nurse should notify the provider about which of the following findings? (Click on the exhibit tabs for additional information about the client. There are three tabs that contain separate categories of data.)

Rationale:

A. Action: The action stage involves actively implementing strategies to change behavior. Since the group is already in the process of reducing pesticide use, they are taking concrete steps toward achieving their goal, which defines the action phase.

B. Maintenance: Maintenance occurs after a behavior has been successfully adopted and sustained over time. The group has not yet reached this phase, as they are still actively working on the change rather than maintaining it.

C. Contemplation: Contemplation is the stage where individuals or groups are considering a change but have not yet committed to or started the process. The group’s involvement in reducing pesticide use suggests they have moved beyond this phase.

D. Preparation: Preparation includes making plans and gathering resources to initiate change. While the group may have gone through this stage, the current activity of reducing pesticide use indicates they have progressed to the action stage.

Rationale for correct choices:

• Apply oxygen via nasal cannula: The client’s oxygen saturation levels of 87–88% on room air indicate moderate to severe hypoxemia, requiring immediate correction. Since the client has a history of COPD and is post-MI, improving oxygenation is essential to reduce myocardial workload and prevent further ischemia or respiratory distress.
• Initiating a consult for cardiac rehabilitation: Once the client's immediate needs are stabilized, early initiation of cardiac rehabilitation is appropriate. This supports physical recovery, promotes lifestyle changes like smoking cessation and exercise, and reduces future cardiac risk.

Rationale for incorrect choices:

• Administer a second dose of nitroglycerin: The client’s chest pain has resolved following the initial dose, so there is no current indication to give a second dose. Re-administering nitroglycerin unnecessarily can lead to hypotension or reflex tachycardia, especially risky in a post-MI patient.
• Request a prescription for a PRN anxiolytic: The client has already been prescribed alprazolam 0.5 mg three times daily, and their anxiety has improved. Requesting an additional anxiolytic is unnecessary at this point and does not address the more urgent issue of low oxygen saturation.
• Requesting a prescription for a WBC count: There are no signs or symptoms of infection such as fever, chills, or elevated WBC to justify this request. The focus should remain on the client’s cardiopulmonary status and rehabilitation rather than diagnostics that are not clinically indicated.
• Administering a bolus of fluids: There is no clinical indication of fluid volume deficit, hypotension, or dehydration. Administering fluids to a post-MI patient with COPD may lead to fluid overload, pulmonary edema, or increased myocardial strain.