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A decreased anteroposterior diameter of the chest is not typically associated with COPD and emphysema. In fact, patients with COPD often have an increased anteroposterior diameter, known as a “barrel chest,” due to hyperinflation of the lungs. This change in chest shape is a compensatory mechanism to accommodate the increased lung volume and is a common physical finding in advanced COPD.

Petechiae on the chest are not a typical finding in COPD or emphysema. Petechiae are small, red or purple spots caused by bleeding into the skin and are usually associated with conditions affecting blood clotting or platelet function. They are not related to the respiratory pathology seen in COPD and emphysema.

Respiratory alkalosis is not commonly associated with COPD and emphysema. These conditions are more likely to cause respiratory acidosis due to chronic retention of carbon dioxide (CO2). In COPD, the damaged alveoli and airways lead to impaired gas exchange, resulting in elevated CO2 levels and a decrease in blood pH. Respiratory alkalosis, characterized by low CO2 levels and increased pH, is more often seen in conditions causing hyperventilation, such as anxiety or acute asthma attacks.

Initiating droplet precautions is not sufficient for a client presenting with symptoms such as coughing up blood, productive cough, and night sweats. These symptoms are indicative of possible tuberculosis (TB), which is an airborne disease. Droplet precautions are used for infections spread through large respiratory droplets, such as influenza or pertussis, but not for TB.

Considering standard precautions to be sufficient is incorrect. Standard precautions are the basic level of infection control that should be used in the care of all patients to prevent the spread of infections. However, for a client with symptoms suggestive of TB, additional airborne precautions are necessary to prevent the spread of the disease.

Transferring the client to a positive pressure room is inappropriate. Positive pressure rooms are designed to keep contaminants out and are used for protecting immunocompromised patients from infections. For a client with suspected TB, a negative pressure room is required to prevent the spread of infectious particles to other areas.

Increasing blood flow back to the heart is not the primary reason for performing arm and shoulder exercises after a thoracotomy. While exercise can improve circulation, the main goal of these specific exercises is to maintain mobility and prevent complications related to immobility.

Promoting the expansion of the left lung is not the primary purpose of arm and shoulder exercises. While deep breathing exercises and the use of an incentive spirometer are crucial for lung expansion and preventing atelectasis, arm and shoulder exercises focus more on maintaining joint and muscle function.

Rebuilding the muscle that was removed is not accurate in this context. Thoracotomy involves accessing the thoracic cavity, and while muscle tissue may be affected, the primary goal of postoperative exercises is to maintain existing muscle function and prevent stiffness, not to rebuild muscle tissue.
 

Effective coughing after medication administration is not specifically required for the use of metered dose inhalers like albuterol and beclomethasone. While coughing can help clear mucus from the airways, it is not a necessary step in the administration of these medications. The primary focus should be on proper inhaler technique to ensure the medication reaches the lungs effectively.

Using beclomethasone as needed when breathing normally is incorrect. Beclomethasone is a maintenance medication that should be used regularly as prescribed, not on an as-needed basis. It helps control chronic inflammation in the airways and prevent asthma symptoms. Using it only when symptoms are not present would not provide the consistent anti-inflammatory effect needed to manage asthma effectively.

Taking the beclomethasone first, followed by the albuterol, is incorrect. The correct sequence is to use the albuterol first. Albuterol is a bronchodilator that works quickly to open up the airways, making it easier for the beclomethasone to reach deeper into the lungs and be more effective

5% dextrose in water (D5W) is not typically used for fluid resuscitation in cases of hypovolemia due to severe bleeding. D5W is a hypotonic solution once the dextrose is metabolized, which means it does not remain in the intravascular space and is not effective in expanding blood volume. It is more commonly used for providing free water and calories.

5% dextrose in 0.25% sodium chloride (D5 1/4 NS) is also not suitable for fluid resuscitation in hypovolemia due to severe bleeding. This solution is hypotonic and will not adequately expand the intravascular volume. It is generally used for maintenance fluids rather than for resuscitation.

3% sodium chloride (3% NaCl) is a hypertonic solution and is not typically used for fluid resuscitation in hypovolemia due to severe bleeding. Hypertonic solutions can cause rapid shifts of fluid from the intracellular to the extracellular space, which can lead to complications such as hypernatremia and osmotic demyelination syndrome. It is generally reserved for specific situations such as severe hyponatremia.

Pulmonary function testing is not the immediate priority for a client with status asthmaticus who is showing signs of respiratory failure, such as diminished breath sounds and confusion. Pulmonary function tests are useful for diagnosing and assessing the severity of asthma but are not appropriate during an acute, life-threatening exacerbation.

A chest x-ray can be useful in diagnosing complications such as pneumothorax or pneumonia in a client with status asthmaticus, but it is not the immediate priority when the client is showing signs of respiratory failure. The primary focus should be on stabilizing the client’s respiratory status.

Administering 2 liters of oxygen via nasal cannula is not sufficient for a client with severe status asthmaticus and signs of respiratory failure. High-flow oxygen delivery methods or mechanical ventilation are required to adequately support the client’s respiratory needs.