A client with chronic obstructive pulmonary disease (COPD) verbalizes concern about continued fatigue and shortness of breath.

Which discharge instruction is MOST appropriate for reducing the client's fatigue and shortness of breath during mealtimes?

Eat frequent, small meals to reduce energy use.

Eat fatty foods to get maximum caloric intake.

Eat simple carbohydrates for quick energy.

Eat the largest meal late at night before sleep.

Answer and Explanation

The Correct Answer is A

Choice A rationale

Small, frequent meals reduce the metabolic and mechanical burden on the respiratory system. Large meals can cause gastric distension, which pushes the diaphragm upward, restricting lung expansion and increasing the work of breathing. By consuming smaller portions throughout the day, the client conserves energy and prevents the severe dyspnea often associated with the pressure of a full stomach against a compromised respiratory tract in chronic obstructive pulmonary disease.

Choice B rationale

High-fat diets are generally avoided as the primary caloric source in respiratory distress unless specifically ordered for low-carbohydrate needs. While fats are calorie-dense, excessive intake can lead to delayed gastric emptying and feelings of fullness that may exacerbate shortness of breath. The goal is a balanced intake that provides sufficient energy without causing abdominal discomfort or significantly increasing the metabolic rate beyond what the client's current oxygen supply can comfortably support for digestion.

Choice C rationale

Simple carbohydrates are metabolized quickly and result in the production of high levels of carbon dioxide as a byproduct. In clients with chronic obstructive pulmonary disease, the ability to exhale carbon dioxide is already impaired. Consuming high amounts of simple sugars can lead to hypercapnia, which increases the respiratory rate and worsens the sensation of fatigue and shortness of breath during and after mealtimes due to the increased ventilatory demand.

Choice D rationale

Eating a large meal late at night before sleeping is inappropriate for a client with respiratory compromise. Lying flat or sleeping shortly after a heavy meal increases the risk of acid reflux and aspiration. Furthermore, the pressure of a full stomach on the diaphragm is most pronounced when the client is in a recumbent position, which can lead to nocturnal dyspnea, poor sleep quality, and significant morning fatigue due to nighttime hypoxia.

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Correct Answer is A

Explanation

Choice A rationale

For a thoracentesis, the client is typically positioned sitting upright, often leaning forward over a bedside table. This position, which is a variation of Fowler's or orthopneic positioning, allows the ribs to expand and shifts the pleural fluid to the base of the pleural cavity. This makes the fluid more accessible for the physician to drain via the needle while minimizing the risk of accidental lung puncture, as the diaphragm is displaced downward by gravity.

Choice B rationale

The supine position, where the client lies flat on their back, is inappropriate for a thoracentesis. In this position, the pleural fluid spreads out along the posterior aspect of the lung, making it much harder to locate and safely aspirate a significant volume. Furthermore, lying flat can increase respiratory distress for a client who already has a pleural effusion, as the fluid puts more pressure on the lungs and reduces the available space for expansion.

Choice C rationale

The prone position, lying on the stomach, is not used for a bedside thoracentesis. This position would make it extremely difficult for the clinician to access the posterior or lateral chest wall where the procedure is typically performed. It would also severely compromise the client's ability to breathe comfortably during the procedure, as chest expansion is restricted against the bed surface, leading to increased anxiety and potential hypoxia during the invasive needle insertion.

Choice D rationale

The lithotomy position involves the client lying on their back with legs elevated in stirrups. This is used for pelvic, urological, or gynecological procedures and has no relevance to a thoracentesis. Placing a client with a pleural effusion in this position would provide no access to the thoracic cavity and would likely worsen their shortness of breath by increasing venous return to the heart and pushing abdominal contents against the diaphragm, further limiting lung volume.

A. Encourage ambulation if allowed out of bed by health care provider. B. Encourage postoperative clients to cough and deep breathe. C. Maintain clients in a supine position at all times to prevent aspiration. D. Educate patient to blow into the incentive spirometer every 2 hours. E. Allow clients who recently had a stroke to feed themselves to promote self-care. F. Educate patient to inhale slow and deep with lips tight around the mouth piece of the incentive spirometer.

Correct Answer is ["A","B","F"]

Explanation

Choice A rationale

Ambulation is a critical intervention for preventing atelectasis because physical movement encourages deeper breathing and the expansion of the lungs. Walking increases the tidal volume and helps mobilize secretions that might otherwise collect in the lower lobes and cause alveolar collapse. By shifting the patient’s position and increasing metabolic demand slightly, ambulation promotes better ventilation-perfusion matching throughout the pulmonary system. It is one of the most effective non-invasive ways to maintain lung health postoperatively.

Choice B rationale

Encouraging coughing and deep breathing is a standard nursing intervention to prevent the collapse of small airways and alveoli. Deep breathing exercises increase the pressure within the lungs, helping to pop open collapsed alveoli through collateral ventilation. Coughing provides the necessary force to move mucus from the smaller airways into the larger ones where it can be expectorated. This reduces the risk of mucus plugging, which is a primary cause of obstructive atelectasis in surgical patients.

Choice C rationale

Maintaining a client in a supine position at all times is actually a risk factor for atelectasis rather than a prevention strategy. When a patient lies flat, the abdominal contents push upward against the diaphragm, and gravity causes the posterior lung fields to be compressed. This restricts full lung expansion and leads to the collapse of the dependent alveoli. Frequent repositioning and elevating the head of the bed are preferred to ensure maximal lung expansion and better gas exchange.

Choice D rationale

This choice is incorrect because the incentive spirometer is designed for inhalation, not exhalation. Educating a patient to blow into the device would not achieve the goal of alveolar expansion. The purpose of the incentive spirometer is to provide visual feedback as the patient takes a slow, deep breath in, which creates sustained maximal inspiration. This process increases transpulmonary pressure and helps re-expand collapsed lung tissue. Blowing into the device would be ineffective for treating atelectasis.

Choice E rationale

While promoting self-care is important for stroke rehabilitation, allowing a patient with a recent stroke to feed themselves without supervision is a safety risk regarding aspiration. Aspiration can lead to pneumonia or focal atelectasis if foreign material enters the bronchial tree. This intervention does not directly target the mechanical expansion of the alveoli or the prevention of lung collapse. Furthermore, stroke patients often have dysphagia, making unmonitored feeding a dangerous practice rather than a preventive lung intervention.

Choice F rationale

Proper technique for using an incentive spirometer involves creating a tight seal around the mouthpiece and inhaling slowly and deeply. A slow, sustained inhalation is necessary to ensure that the air reaches the most distal parts of the lungs, including the alveoli that are at risk of collapsing. The goal is to reach a target volume and hold the breath for several seconds to maximize the recruitment of lung tissue. This specific educational point is essential for effective treatment.

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A client with chronic obstructive pulmonary disease (COPD) verbalizes concern about continued fatigue and shortness of breath. Which discharge instruction is MOST appropriate for reducing the client's fatigue and shortness of breath during mealtimes?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client is being prepared for a bedside thoracentesis for a pleural effusion. The nurse prepares the client by placing the client in which position?

Correct Answer is A

Explanation

Which interventions prevent or treat atelectasis? Select all that apply.

Correct Answer is ["A","B","F"]

Explanation

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A client with chronic obstructive pulmonary disease (COPD) verbalizes concern about continued fatigue and shortness of breath.

Which discharge instruction is MOST appropriate for reducing the client's fatigue and shortness of breath during mealtimes?