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 D

Explanation

Choice A Reason
While maintaining a stable blood pressure is important for a client with hypertension, furosemide is primarily a diuretic, and its therapeutic effect is to reduce fluid overload, not directly to stabilize blood pressure. Therefore, this finding alone does not best indicate the therapeutic effect of furosemide.

Choice B Reason
Clear lungs upon auscultation suggest an improvement in pulmonary edema, which can be associated with fluid overload in conditions such as heart failure. However, for a client with peripheral edema, the primary therapeutic goal of furosemide is to reduce the excess fluid in the extremities, not just the lungs.

Choice C Reason
A decrease in serum potassium is a known side effect of furosemide due to its action on the kidneys, leading to increased excretion of potassium. While it's important to monitor for hypokalemia, a decrease in potassium does not directly indicate the therapeutic effect of reducing edema.

Choice D Reason
An increase in urine output from 30 mL per hour to 100 mL per hour is a direct indication that furosemide is achieving its therapeutic effect. Furosemide is a loop diuretic that increases urine production to help the body eliminate excess fluid, thereby reducing edema associated with conditions like hypertension.

A. "I've had gas pains for the last day." B. "I've had a headache for a couple of days." C. "I have occasional constipation." D. "My legs feel weak, and I get pain in my calves."

Correct Answer is D

Explanation

Choice A Reason:

Gas pains, while uncomfortable, are not typically a serious adverse effect of simvastatin and do not usually require immediate medical attention unless they are severe or persistent.

Choice B Reason:

Headaches are a common side effect of many medications, including simvastatin, and are not generally considered an emergency. However, if the headache is severe, persistent, or accompanied by other symptoms, it should be reported to a healthcare provider.

Choice C Reason:

Occasional constipation is another common side effect and is not usually a cause for immediate concern unless it becomes severe or chronic.

Choice D Reason:

Muscle weakness and pain, especially in the calves, can be a sign of a serious condition called rhabdomyolysis, which is a rare but serious adverse effect of statins like simvastatin. This condition involves the breakdown of muscle tissue and can lead to kidney damage. It should be reported to a healthcare provider immediately.

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Naxlex Comprehensive Predictor Exams

After administering furosemide 20 mg PO to a client diagnosed with hypertension and peripheral edema, which finding would best indicate that the therapeutic effect of the medication has been achieved?

Correct Answer is D

Explanation

A nurse is assessing a client who has been taking simvastatin to treat hyperlipidemia. Which statement made by the client describes an adverse effect of the medication that should be reported to the provider immediately?

Correct Answer is D

Explanation

Which medication should the nurse question for a client admitted with an exacerbation of chronic obstructive pulmonary disease (COPD)?

A client with Type 2 diabetes, controlled with diet and metformin, also has chronic obstructive pulmonary disease (COPD). During an exacerbation of COPD, the client is prescribed prednisone to control inflammation. For which side effect should the nurse monitor the client?

The nurse is providing discharge teaching to a client with angina pectoris who is prescribed metoprolol 50 mg PO daily. Which information should the nurse include in the teaching?

Which statement, made by the client diagnosed with unstable angina, reflects an understanding of the nurse's discharge teaching?

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

A client is scheduled for a coronary angiography. In reviewing the client's record, what significant finding should the nurse report to the healthcare provider prior to this procedure?

The nurse is sitting with a client diagnosed with schizophrenia, who starts to laugh uncontrollably, although the nurse has not said anything funny. The nurse should say:

A client with chronic peripheral arterial disease (PAD) asks the nurse why this disease developed. Which explanation by the nurse is most accurate?