A nurse assesses a client with chronic obstructive pulmonary disease.
Which Questions would the nurse ask to determine the client's activity tolerance? (Select all that apply.)

Choice A rationale

While understanding the spouse's fear is important for a holistic approach, it does not directly address the underlying knowledge deficit or provide a solution to mitigate the perceived risk. The fear likely stems from a lack of understanding regarding transmission and protective measures for tuberculosis, which requires specific education to overcome.

Choice B rationale

Informing the spouse that precautions protect other clients is true but does not alleviate the spouse's personal fear of contracting the disease. The spouse's primary concern is self-preservation and protecting themselves from potential infection, which needs to be directly addressed by demonstrating safety protocols.

Choice C rationale

This action directly empowers the spouse by providing concrete education and demonstration of proper isolation techniques. Understanding and practicing these precautions, such as donning and doffing personal protective equipment and hand hygiene, significantly reduces perceived and actual transmission risk, promoting a sense of safety and control.

Choice D rationale

Stating that the spouse has already been exposed can be misleading and may not be entirely accurate, as exposure does not guarantee infection. Furthermore, it dismisses the spouse's valid anxieties about active disease transmission from a hospitalized individual, potentially fostering mistrust rather than alleviating fear and encouraging visits.

Choice A rationale

Cromolyn is a mast cell stabilizer that works by inhibiting the release of inflammatory mediators (e.g., histamine, leukotrienes) from mast cells. Its mechanism of action is prophylactic, meaning it prevents the cellular cascade leading to bronchospasm when administered before exposure to a trigger, such as exercise. It has no bronchodilatory effect.

Choice B rationale

Administering cromolyn at the initial onset of an attack is ineffective because it does not have acute bronchodilatory properties. Once the inflammatory cascade is initiated and bronchoconstriction has begun, cromolyn cannot reverse the symptoms. Rescue inhalers like albuterol are needed for acute symptom relief.

Choice C rationale

Cromolyn is a prophylactic medication and does not provide symptomatic relief during an acute asthma attack. Its role is to stabilize mast cells to prevent the release of inflammatory mediators that cause bronchoconstriction and inflammation. Therefore, it is not used to alleviate symptoms once an attack is in progress.

Choice D rationale

While cromolyn can be prescribed for regular daily use, the specific instruction for exercise-induced asthma is to take it before exercise. Taking it as often as 4 times a day without considering the timing relative to triggers may not be optimal for preventing exercise-induced symptoms, as its effect is primarily preventive.