A client with chronic obstructive pulmonary disease (COPD) has poor gas exchange. Which action by the nurse would support the client's ventilation?

Encourage the client to sit up at the bedside in a chair and lean forward.

Have the client rest in bed with the head elevated 15 to 20 degrees.

Place the client in the Trendelenburg position with pillows behind the head.

Ask the client to rest in bed in a high- Fowlers position with the knees flexed.

Answer and Explanation

The Correct Answer is A

A. Sitting up and leaning forward helps improve lung expansion and ventilation, which is beneficial for clients with COPD.

B. Elevating the head is helpful but not as effective as sitting upright for COPD clients who need to improve their ventilation.

C. The Trendelenburg position is not appropriate for improving ventilation in COPD patients.

D. While high-Fowler's may help in some situations, having the knees flexed can restrict the diaphragm and limit breathing capacity.

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Correct Answer is D

Explanation

A. Assuming the client is someone else's spouse based on a name may be inappropriate and could lead to misunderstanding.

B. The chart may not necessarily contain an error, and jumping to conclusions could be unprofessional.

C. Apologizing and declaring confusion may make the client uncomfortable. It's more respectful to inquire directly.

D. Asking the client about their preferred form of address is the most respectful and professional approach.

A. Instruct the client to drink water. B. Hold the next dose. C. Initiate oxygen therapy. D. Administer PRN acetaminophen.

Correct Answer is D

Explanation

A. Drinking water is not likely to alleviate the headache caused by the nitrate.

B. Holding the next dose is not necessary unless the headache becomes severe or is associated with other symptoms.

C. Initiating oxygen therapy is unnecessary for a headache caused by nitrate use.

D. A headache is a common side effect of nitrate administration due to the vasodilation effect. Administering PRN acetaminophen can help relieve the headache.

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