The nurse is assessing the client diagnosed with COPD. Which of the following would require immediate attention by the nurse?

Use of accessory muscles during inspiration.

Large amounts of thick white sputum

Presence of a barrel chest and clubbing

Oxygen flowmeter set on 8 LPM

Answer and Explanation

The Correct Answer is D

A. Use of accessory muscles during inspiration is common in COPD as clients work harder to breathe. While this indicates respiratory distress, it is not necessarily an immediate emergency.
B. Large amounts of thick white sputum can indicate mucus production, which is common in COPD. If the sputum were yellow or green, it could suggest infection, requiring further assessment.
C. A barrel chest and clubbing are chronic changes in COPD due to prolonged air trapping and hypoxia. These findings do not require immediate intervention.
D. Oxygen flowmeter set on 8 LPM is correct. High-flow oxygen can suppress the hypoxic drive in COPD clients, leading to respiratory depression. The nurse should immediately lower the oxygen to a safer level (typically 1-3 LPM) and monitor the client’s respiratory status.

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Correct Answer is C

Explanation

A. Annual Influenza immunization is important for individuals with chronic bronchitis but does not directly prevent the disorder from occurring. It helps reduce respiratory infections, which can exacerbate symptoms.
B. Regular moderate exercise improves overall lung function but does not specifically prevent chronic bronchitis.
C. Smoking cessation is the most effective measure in preventing chronic bronchitis. Chronic bronchitis is strongly linked to long-term cigarette smoking, which causes inflammation and excessive mucus production in the airways.
D. Maintenance of ideal weight supports overall health but is not a primary factor in preventing chronic bronchitis.

A. "I recommend you exercise daily and avoid smoking to decrease your risk." B. “Tell me more about these fears of dying from a heart attack." C. "Of course you aren't going to die, at least not in the immediate future." D. "Perhaps you should discuss this with your physician.”

Correct Answer is B

Explanation

A. Providing health recommendations is important, but the immediate concern is addressing the client's fear.
B. Encouraging the client to express emotions allows the nurse to assess and provide appropriate emotional support.
C. Dismissing the client's fears can make them feel unheard and may increase anxiety.
D. Referring the client to the physician too soon may shut down communication and miss an opportunity for emotional support.

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