A nurse is caring for a client with a medical diagnosis of acute exacerbation of chronic obstructive pulmonary disease (COPD). The client's assessment reveals a respiratory rate of 28/min, SpO2 at 90%, and complaints of mild dyspnea and anxiety at rest. What should the nurse include in the client's discharge teaching plan?

Use bronchodilators every 2 hours as needed.

Instructions on pursed-lip breathing.

Increase home oxygen from 3L/min to 5L/min as needed.

Use huff coughing to loosen secretions.

Answer and Explanation

The Correct Answer is B

Choice A reason:
Using bronchodilators every 2 hours as needed may not be appropriate for all clients. Bronchodilators are typically used on a schedule or as needed based on symptoms, but overuse can lead to tolerance and decreased effectiveness. The nurse should provide education on the proper use and timing of bronchodilators.

Choice B reason:
Pursed-lip breathing is a technique that helps control shortness of breath and improve ventilation. It can slow down the client's breathing, promote relaxation, and ensure more effective lung function. This technique is particularly beneficial during an acute exacerbation of COPD and should be included in the discharge teaching plan.

Choice C reason:
Increasing home oxygen without proper assessment can be dangerous. Oxygen therapy should be titrated based on the client's oxygen saturation and clinical status. Clients with COPD are at risk of CO2 retention, and too much oxygen can suppress their drive to breathe. The nurse should educate the client on monitoring their SpO2 and when to adjust oxygen levels, typically under the guidance of a healthcare provider.

Choice D reason:
Huff coughing is a technique used to clear mucus from the airways. While it can be effective, it should be taught by a respiratory therapist or nurse who can assess the client's ability to perform the technique correctly. It is not the first-line teaching for a client being discharged with an acute exacerbation of COPD.

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Correct Answer is B

Explanation

Choice A Reason:
The statement "Forget him. There are other fish in the sea." minimizes the client's feelings and does not acknowledge the emotional pain they are experiencing. It is a cliché that can come across as dismissive rather than empathetic.

Choice B Reason:
"You must have been very upset to do what you did." This statement acknowledges the client's distress and does not judge their actions. It reflects an understanding of the depth of their emotional pain, which is a key component of empathy.

Choice C Reason:
"Don't worry, you'll get over him in time." While this statement may be intended to provide reassurance, it does not address the immediate emotional state of the client. It could be perceived as brushing aside their current feelings.

Choice D Reason:
"Why do you think your boyfriend broke up with you?" This question could be seen as probing for information rather than offering support. It might imply that the client is at fault for the breakup, which is not an empathetic approach.

A. The client is free of chest pain and dyspnea. B. The client describes the importance of increasing fluid intake. C. The client increases aerobic exercises to promote endurance. D. The client's acute pain is controlled at 3 on a standard pain scale.

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

Explanation

Choice A reason:
Being free of chest pain and dyspnea is a significant indicator of successful nursing intervention in a sickle cell crisis. Chest pain and dyspnea can occur due to acute chest syndrome, a life-threatening complication of sickle cell disease characterized by vaso-occlusion in the pulmonary microcirculation. Effective pain management and oxygen therapy can alleviate these symptoms, reflecting improved respiratory function and gas exchange.

Choice B reason:
Educating the client on the importance of increasing fluid intake is crucial in managing sickle cell crisis. Adequate hydration helps to reduce blood viscosity and prevent sickling of red blood cells, which can lead to vaso-occlusive episodes. When a client verbalizes understanding and the importance of hydration, it demonstrates the effectiveness of patient education and the client's engagement in self-care.

Choice C reason:
While increasing aerobic exercises may promote endurance, it is not typically a short-term outcome measure for a sickle cell crisis. Exercise must be approached with caution in these clients, as it can increase the risk of a vaso-occlusive crisis due to dehydration and increased oxygen demand during a sickle cell crisis.

Choice D reason:
Control of acute pain to a level of 3 on a standard pain scale indicates successful pain management, a primary goal in the treatment of sickle cell crisis. Pain in sickle cell crisis is due to ischemia from obstructed blood flow by sickled cells. Effective analgesic administration and pain management strategies are essential to achieve this outcome.

Choice E reason:
A leukocyte count of 18,000/mm³ is above the normal range (4,500 to 11,000/mm³) and may indicate an infection or inflammation, which are common complications of sickle cell disease. However, this is not a direct outcome of nursing interventions aimed at managing a sickle cell crisis and thus is not a correct choice.

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Naxlex Comprehensive Predictor Exams

Which statement shows that the nurse has empathy for a client who has recently made a suicide attempt after breaking up with a significant other?

Correct Answer is B

Explanation

How can the nurse determine that the outcomes of nursing interventions have been successful for the client diagnosed with a sickle cell crisis? (SELECT ALL THAT APPLY)

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

Explanation

A client is prescribed lisinopril 20 mg PO daily for the treatment of hypertension. Which finding would alert the nurse that a side effect of the medication has occurred?

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The nurse would include which teaching or intervention in the care plan of a client experiencing diarrhea related to antibiotic therapy?

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