A client with COPD who smokes 1 PPD presents for a routine appointment. Which client statement causes the nurse to suspect an increase in dyspnea?

"I prop myself up at night to sleep."

"I decided to put on some makeup today."

I have a productive cough in the morning."

"I have gained weight since I was here last."

Answer and Explanation

The Correct Answer is A

A. The statement "I prop myself up at night to sleep" indicates orthopnea, which is difficulty breathing when lying flat. Orthopnea occurs because in clients with COPD, the lungs have reduced elastic recoil and airflow obstruction, leading to air trapping and hyperinflation. When lying flat, the diaphragm is compressed, and the lungs cannot fully expand, worsening shortness of breath. Needing to use pillows or sit upright to sleep is a key sign of worsening respiratory function or increased dyspnea. This symptom signals that the client’s COPD may be progressing or that there is an acute exacerbation, requiring prompt assessment of oxygenation, lung sounds, and respiratory effort.

B. Saying "I decided to put on some makeup today" reflects engagement in activities of daily living and suggests that the client has functional capacity and energy. This statement does not indicate increased shortness of breath.

C. A productive morning cough is a chronic symptom of COPD caused by excess mucus production and impaired mucociliary clearance. While it is part of the disease process, it does not necessarily indicate an acute increase in dyspnea unless it is accompanied by other symptoms such as increased sputum, wheezing, or shortness of breath.

D. Weight gain could be related to fluid retention, dietary changes, or other factors, but on its own it does not directly indicate worsening dyspnea. If associated with edema or orthopnea, it may suggest heart failure, but without these signs, it is not the primary indicator of increased respiratory distress.

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Correct Answer is D

Explanation

A. The Rapid Shallow Breathing Index (RSBI) is calculated as the ratio of respiratory rate to tidal volume (in liters). An RSBI <105 is generally considered favorable for weaning. A value of 85 indicates the patient is breathing efficientlyand may be ready to wean.

B. Negative inspiratory force measures inspiratory muscle strength. Values more negative than -20 to -30 cm H2O are considered adequate. A NIF of -28 cm H2O indicates sufficient inspiratory strengthfor spontaneous breathing.

C. A tidal volume ≥5 mL/kg is generally acceptable for weaning. A value of 6 mL/kg indicates adequate ventilationduring spontaneous breathing trials.

D. A FiO2 >40% to maintain adequate oxygen saturation indicates ongoing oxygenation impairment, suggesting the client may not yet be ready for weaning. Successful weaning usually requires an FiO2 ≤40% and PEEP ≤5 cm H2O to maintain SpO2 ≥90–92%, ensuring the lungs can sustain oxygenation without excessive support.

A. Blunt injury B. Thermal injury C. Laceration injury D. Penetrating injury

Correct Answer is A

Explanation

A. A blunt injury occurs when the body is struck by a non-sharp objector force, causing tissue damage without breaking the skin. A baseball bat delivers direct force to the abdomen, potentially resulting in internal bleeding, organ contusions, or hematomas, which are characteristic of blunt trauma.

B. Thermal injuries are caused by heat, fire, or extreme cold, resulting in burns or frostbite, which is unrelated to trauma from a baseball bat.

C. Lacerations involve a tear or cut in the skin or underlying tissue, usually caused by a sharp object. In this scenario, the skin may remain intact despite internal injury, so a laceration is not the primary classification.

D. Penetrating injuries occur when a sharp object pierces the skin and enters body tissues, such as a knife or bullet. A baseball bat does not penetrate the skin, so this type does not apply.

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A client with COPD who smokes 1 PPD presents for a routine appointment. Which client statement causes the nurse to suspect an increase in dyspnea?

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Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

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Correct Answer is A

Explanation

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