A client with chronic bronchitis has a non-productive cough, rhonchi in bilateral lung fields, and difficulty expectorating the secretions. Which intervention should the nurse incorporate into the plan of care?
Place the client on a 35% Venturi mask.
Encourage the client to increase liquid intake throughout the day.
Administer dextromethorphan 30 mg PO every six hours as needed.
Encourage pursed-lip breathing when the client is out of bed.
The Correct Answer is B
Choice a reason:
Placing the client on a 35% Venturi mask would provide a controlled amount of oxygen which is beneficial for clients with chronic obstructive pulmonary disease (COPD) who may retain carbon dioxide. However, this intervention is not directly related to the management of a non-productive cough and difficulty expectorating secretions.
Choice b reason:
Encouraging the client to increase liquid intake throughout the day can help thin the bronchial secretions, making them easier to expectorate. Adequate hydration is essential in the management of chronic bronchitis to help clear mucus from the airways.
Choice c reason:
Administering dextromethorphan, a cough suppressant, may be used to control a non-productive cough. However, it would not assist with the expectoration of secretions and could potentially inhibit the cough reflex needed to clear the airways.
Choice d reason:
Encouraging pursed-lip breathing can help improve ventilation and oxygenation by promoting more effective exhalation. This technique can be beneficial for clients with COPD but does not directly address the issue of expectorating secretions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice a reason:
For individuals with Crohn's disease, eating three large meals may not be the best approach as it can overwhelm the digestive system. Smaller, more frequent meals are often recommended to ease the digestion process and better manage symptoms.
Choice b reason:
Drinking water during meals can help with digestion, but there is no specific requirement to limit it to ten ounces. Adequate hydration is important, but the amount should be tailored to individual needs and tolerances.
Choice c reason:
Choosing coffee over cola is not necessarily beneficial for Crohn's disease management. Both beverages can potentially irritate the gastrointestinal tract, and individuals with Crohn's disease are often advised to limit caffeine and carbonated drinks.
Choice d reason:
Increasing protein intake can be beneficial for clients with Crohn's disease, especially if they have experienced weight loss or malnutrition due to their condition. Protein is essential for healing and repair of tissues, and maintaining adequate protein levels is important for overall health.
Correct Answer is A
Explanation
Choice a reason:
Risperidone is an antipsychotic medication that can help manage both positive symptoms (such as delusions and hallucinations) and negative symptoms (such as apathy and social isolation) of schizophrenia. Monitoring both types of symptoms is essential to evaluate the overall effectiveness of the treatment. Positive symptoms are often more responsive to medication, while negative symptoms can be more challenging to treat and may require a comprehensive approach including psychosocial interventions.
Choice b reason:
Disorganized symptoms, which include disorganized speech and behavior, are another aspect of schizophrenia that can be impacted by risperidone. While these symptoms are not mentioned in the client's current presentation, they are still important to monitor as part of a comprehensive assessment of the client's condition.
Choice c reason:
Negative symptoms like apathy and social isolation can significantly impact a client's quality of life and functional abilities. Risperidone can help improve these symptoms, but they often require longer treatment duration and additional supportive therapies for significant improvement.
Choice d reason:
Positive symptoms such as delusions and hallucinations are critical targets for risperidone treatment. These symptoms can be distressing and disruptive, and their improvement is a key indicator of the medication's effectiveness. Monitoring the reduction or resolution of these symptoms is crucial for assessing the client's response to risperidone.
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