A home health nurse is assessing a client who has COPD. Which of the following findings indicates the need for a referral for pulmonary rehabilitation?

Dyspnea at rest

Pursed-lip breathing

Clubbing of the fingers

SP02 90%

Answer and Explanation

The Correct Answer is A

Rationale:

A. Dyspnea at rest: Dyspnea at rest is a sign of advanced COPD, indicating that the client is experiencing significant respiratory difficulty. Pulmonary rehabilitation can help improve exercise tolerance and breathing, making this an appropriate reason for referral.

B. Pursed-lip breathing: Pursed-lip breathing is a technique often used by clients with COPD to help manage shortness of breath. It is not an indication for pulmonary rehabilitation, but rather a self-management strategy.

C. Clubbing of the fingers: Clubbing of the fingers can be a sign of chronic hypoxia and is commonly seen in advanced COPD. However, it does not directly indicate the need for pulmonary rehabilitation, although the condition may benefit from comprehensive care.

D. SPO2 90%: A SpO2 of 90% is low but not necessarily an indication for referral to pulmonary rehabilitation. It is important to monitor oxygen levels, but this alone does not trigger the need for rehabilitation.

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Correct Answer is D

Explanation

Rationale:

A. "We will change the dressing daily." The dressing for a PICC is typically changed every 7 days, or sooner if it becomes wet or soiled. Changing it daily is not necessary unless there is a specific indication for more frequent changes, such as infection or drainage.

B. "We can measure your blood pressure in either arm." It is not recommended to measure blood pressure in the arm with the PICC line as this could increase the risk of complications, such as dislodging the catheter or causing discomfort. BP should be measured in the opposite arm.

C. "We will replace the PICC every month." It is a long-term catheter, used for several months, unless there are complications or it needs to be replaced due to malfunction or infection. Regular assessments and care are necessary, but replacement is not routine monthly.

D. "We can draw blood samples from the PICC for diagnostic tests." The PICC line is often used for drawing blood samples, as it provides easy access to the central venous system. Blood can be drawn from the PICC for diagnostic tests, which is one of its primary uses in chemotherapy patients.

A. "Once I take this for a while, I won't need my inhaler anymore." B. "I'll take this medication every day, even when I don't have symptoms." C. "I'll take this medication to stop wheezing when I have an attack." D. "I'll make sure I take these tablets on an empty stomach."

Correct Answer is B

Explanation

Rationale:

A. "Once I take this for a while, I won't need my inhaler anymore." Montelukast is a maintenance medication not a rescue medication. Clients will still need their inhalers for acute asthma attacks, as montelukast is used to prevent symptoms, not provide immediate relief.

B. "I'll take this medication every day, even when I don't have symptoms." Montelukast is meant to be taken daily to prevent asthma symptoms. Taking it consistently, even when symptoms aren't present, helps reduce inflammation and prevent asthma attacks.

C. "I'll take this medication to stop wheezing when I have an attack." Montelukast is not a fast-acting medication and doesn't stop acute wheezing during an asthma attack. Short-acting bronchodilators like albuterol are used for immediate relief during an asthma attack.

D. "I'll make sure I take these tablets on an empty stomach." Montelukast can be taken with or without food, and it does not require an empty stomach. There are no specific instructions regarding food intake, so it can be taken as prescribed at any time of day.

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A home health nurse is assessing a client who has COPD. Which of the following findings indicates the need for a referral for pulmonary rehabilitation?

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