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Place the head of the patient's bed flat: Positioning the patient flat does not address the underlying issue of excessive bubbling. This intervention has no effect on the integrity of the chest tube system or on resolving the possible air leak.

Milk the chest tube: Milking or stripping chest tubes is not recommended because it can create high negative pressures and damage lung tissue. This action does not correct excessive bubbling and may worsen patient outcomes.

Disconnect the system and get another: Disconnecting the system increases the risk of introducing air into the pleural space, potentially leading to a tension pneumothorax. Replacing the system may be needed, but it should not be done before assessing and notifying the healthcare provider.

Bland, soft diet: While easier to chew, a bland soft diet does not specifically meet the increased nutritional needs of COPD clients. It may be helpful in other conditions but is not the best choice here.

Low-fat, low-cholesterol diet: Although heart-healthy, this diet does not address the elevated energy and protein demands of COPD. Restricting fat unnecessarily can limit caloric intake, worsening malnutrition in these clients.

Low-sodium, high-calorie diet: Sodium restriction is more critical for conditions like hypertension or heart failure. In COPD, the emphasis should be on high-calorie and high-protein intake rather than sodium control unless comorbidities require it.

To strengthen the intercostal muscles: Pursed-lip breathing does not primarily target muscle strengthening. Instead, it helps regulate airflow and improve gas exchange, making this outcome inaccurate.

To promote oxygen intake: While pursed-lip breathing may indirectly improve oxygenation, its main goal is not to increase oxygen intake but to prevent air trapping and improve ventilation.

To strengthen the diaphragm: Diaphragmatic breathing helps strengthen the diaphragm, but pursed-lip breathing specifically works to control exhalation and prevent alveolar collapse, not muscle conditioning.

Scattered rhonchi and crackles with an elevated WBC count: These findings suggest an acute respiratory infection or pneumonia, not chronic hypoxemia. Elevated WBC count points to infection rather than a long-term adaptation to COPD.

Copious amounts of rust-colored sputum with cyanosis: Rust-colored sputum is typically associated with bacterial pneumonia, particularly pneumococcal infection, not chronic hypoxemia. Cyanosis may occur, but the sputum description makes this finding less appropriate.

Distended neck veins and dependent edema: These findings are consistent with cor pulmonale or right-sided heart failure, a complication of COPD, but they are not the expected baseline findings of chronic hypoxemia itself.

Pleural effusion: This involves fluid accumulation in the pleural space, leading to diminished breath sounds and dyspnea. However, it typically develops gradually, not with sudden onset following trauma.

Asthma exacerbation: Asthma usually presents with wheezing, prolonged expiration, and airway inflammation. The absence of wheezing and the presence of unequal chest excursion make this less likely.

Pulmonary embolism: This causes sudden dyspnea and chest pain, but breath sounds are usually normal or clear. The presence of trauma, decreased breath sounds, and unequal chest expansion makes pulmonary embolism less consistent with this case.

"The next scheduled nebulizer treatment will be skipped.": Skipping the next treatment without evaluation may compromise airway management. Albuterol is essential for bronchodilation, and withholding it could worsen respiratory distress.

"I will hold the respiratory medication for 24 hours.": Holding albuterol for 24 hours is unsafe, as the client may experience worsening bronchospasm or hypoxemia. Adjustments should only be made with provider guidance, not independently by the nurse.

"I will request medication for anxiety from the healthcare provider.": Anxiety in this context is a medication side effect, not a psychiatric condition. Treating it with additional medication is unnecessary when monitoring and reassurance are more appropriate.

Compensated metabolic acidosis with hypoxemia: Metabolic acidosis would show a low pH with low HCO₃⁻, but here the bicarbonate is elevated (31), indicating renal compensation rather than a metabolic cause.

Partially compensated metabolic alkalosis: Metabolic alkalosis is characterized by elevated pH and high HCO₃⁻. In this case, the pH is low (7.33), which rules out alkalosis as the primary problem.

Fully compensated respiratory acidosis: Full compensation occurs when the pH returns to normal. Since the pH is still below 7.35, the acidosis remains only partially compensated.

Distant heart sounds: While this may be present in COPD due to hyperinflation of the lungs, it is not immediately life-threatening and does not require urgent action compared to severe dyspnea.

Diminished lung sounds: This is common in COPD due to air trapping and hyperinflation but does not always indicate acute deterioration unless accompanied by other distress signs.

Pursed-lip breathing: This is actually a beneficial compensatory mechanism that helps keep airways open longer to improve carbon dioxide elimination and is not a sign of acute danger.