A client that was recently diagnosed with active tuberculosis is being sent home on combination therapy of Rifampin and Isoniazid.

The nurse determines that the client needs additional education if the patient states:

Choice A rationale

Patients with COPD should actually avoid lying flat after eating. Digestion requires significant blood flow and can cause abdominal distention, which pushes against the diaphragm and makes breathing more difficult. It is usually recommended that these patients sit upright or remain active in a limited capacity after meals to prevent respiratory compromise. Small, frequent meals are also advised to prevent the stomach from becoming too full and impeding the downward movement of the diaphragm.

Choice B rationale

Using the upper chest for respiration, also known as accessory muscle breathing, is often a sign of respiratory distress and is inefficient. It requires more energy and yields less oxygen than diaphragmatic breathing. The nurse should instead encourage abdominal or diaphragmatic breathing to maximize lung expansion and reduce the metabolic cost of breathing. Chronic use of upper chest muscles leads to muscle fatigue and can worsen the patient's overall feeling of exhaustion.

Choice C rationale

Pursed-lip breathing creates positive end-expiratory pressure in the airways. This extra pressure helps keep the bronchioles open during exhalation, allowing for more complete emptying of the lungs and reducing air trapping, which is a hallmark of COPD. By slowing the respiratory rate and improving the exchange of oxygen and carbon dioxide, it helps the patient gain better control over their breathing and reduces the anxiety often associated with the sensation of shortness of breath.

Choice D rationale

Restricting fluids is generally contraindicated for COPD patients unless they have heart failure. Fluid intake should actually be encouraged, often up to 2 to 3 L/day, to help thin pulmonary secretions. Thin secretions are much easier to expectorate, which helps clear the airways and reduces the risk of respiratory infections. Limiting fluids to less than 1 L/day would lead to thick, tenacious mucus that could cause airway obstruction and increase the work of breathing.

Choice A rationale

Oxygen therapy, even at low flow rates like 2 liters per minute, has a significant drying effect on the delicate mucous membranes of the nasal passages. When the nasal mucosa becomes excessively dry, it can lead to crusting, irritation, and even minor bleeding. Adding humidification to the oxygen source introduces moisture into the inhaled gas, which helps to rehydrate the tissues, loosen dried secretions, and prevent further trauma to the nares.

Choice B rationale

Removing the nasal cannula is not a viable priority intervention because the patient was prescribed oxygen therapy for chronic obstructive pulmonary disease. This condition often results in chronic hypoxemia and hypercapnia, requiring a stable fraction of inspired oxygen to maintain adequate systemic oxygenation. Abruptly discontinuing the oxygen could lead to respiratory distress or a drop in arterial oxygen saturation levels, which would jeopardize the patient's respiratory stability and overall clinical safety.

Choice C rationale

Increasing the oxygen flow rate to 5 liters per minute would be counterproductive and potentially dangerous. Higher flow rates without humidification significantly increase the rate of evaporation from the nasal mucosa, which would exacerbate the crusting and bleeding already observed. Furthermore, in patients with chronic obstructive pulmonary disease who may rely on a hypoxic drive to breathe, excessive oxygen administration can suppress the respiratory drive, leading to dangerous carbon dioxide retention and respiratory acidosis.

Choice D rationale

Applying petroleum jelly or other oil-based products to the nostrils while a patient is receiving oxygen therapy is contraindicated due to a significant safety risk. Petroleum is a combustible substance, and in an oxygen-rich environment, it can pose a fire hazard or cause localized burns if an ignition source is present. Additionally, if petroleum jelly is inhaled into the lungs, it can lead to lipid pneumonia, which is a serious inflammatory condition of the lung parenchyma.