A nurse is developing a plan of care for a client who has COPD.
The nurse should include which of the following interventions in the plan?

Restrict the client's fluid intake to less than 2 liters per day.

Provide the client with a low-protein diet.

Instruct the client to use pursed-lip breathing.

Have the client use the early-morning hours for exercise and activity.

Answer and Explanation

The Correct Answer is C

Choice A rationale

Restricting fluid intake in clients with COPD can lead to thickened secretions, making them more difficult to expectorate. Adequate hydration (typically 2-3 liters per day unless contraindicated) is crucial for maintaining thin, mobile respiratory secretions, which facilitates mucociliary clearance and reduces the risk of mucus plugging and subsequent exacerbations. This restriction would hinder respiratory hygiene.

Choice B rationale

Clients with COPD often experience increased metabolic demands due to the effort of breathing and may be at risk for malnutrition and muscle wasting. A low-protein diet would be detrimental, as protein is essential for maintaining respiratory muscle strength, tissue repair, and immune function. A high-protein, high-calorie diet is often recommended to support their nutritional status and overall health.

Choice C rationale

Pursed-lip breathing is a technique that helps clients with COPD by increasing intrabronchial pressure, which prevents premature airway collapse during exhalation, particularly in those with emphysema. This prolongs exhalation, improves gas exchange by allowing more complete emptying of the lungs, reduces air trapping, and can alleviate dyspnea, improving ventilatory efficiency.

Choice D rationale

For clients with COPD, exercising and engaging in activities during early-morning hours can be problematic. This is often the time when respiratory secretions are most abundant and tenacious due to nocturnal accumulation. Engaging in strenuous activity then can exacerbate dyspnea and increase the risk of bronchospasm or fatigue, making later parts of the day often more suitable for activity.

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Correct Answer is A

Explanation

Choice A rationale

Kyphosis, an exaggerated outward curvature of the thoracic spine, is a common spinal deformity in older adults with osteoporosis. This occurs due to vertebral compression fractures, where the weakened bone structure collapses anteriorly, leading to a "hunchback" appearance and loss of height, affecting posture and balance.

Choice B rationale

Ankylosis refers to the stiffening and immobility of a joint due to fusion of bones. While joint issues can occur in older adults, ankylosis is not a direct spinal deformity associated with osteoporosis; rather, it is more commonly linked to inflammatory conditions like ankylosing spondylitis or severe osteoarthritis.

Choice C rationale

Scoliosis is a lateral curvature of the spine, often appearing as an S or C shape. While it can occur in older adults, it is not primarily a direct consequence or expected spinal deformity of osteoporosis. Adult degenerative scoliosis is often due to disc degeneration and facet joint arthritis, not solely bone demineralization.

Choice D rationale

Lordosis is an excessive inward curvature of the lumbar spine. While some degree of lumbar lordosis is normal, hyperlordosis can occur, but it is not the characteristic spinal deformity expected in osteoporosis. Osteoporosis typically leads to kyphosis due to anterior wedging of vertebral bodies, not increased lumbar curvature.

A. Creatinine and BUN. B. White blood cell count. C. Red blood cell count. D. Liver enzymes.

Correct Answer is D

Explanation

Choice A rationale

Creatinine (normal range: 0.6-1.2 mg/dL) and Blood Urea Nitrogen (BUN) (normal range: 7-20 mg/dL) are indicators of kidney function. While kidney function is important, valproate is primarily metabolized by the liver, making liver function monitoring more critical than routine renal function assessment for this medication.

Choice B rationale

White blood cell count (normal range: 4,000-11,000 cells/µL) measures components of the immune system. Although some anticonvulsants can affect blood counts, valproate's primary adverse effect profile does not typically involve significant or common alterations in white blood cell count requiring routine monitoring.

Choice C rationale

Red blood cell count (normal range: 4.2-5.4 million cells/µL for women; 4.7-6.1 million cells/µL for men) measures oxygen-carrying capacity. While certain medications can cause anemia, valproate is not commonly associated with significant hematological toxicities involving red blood cells that necessitate routine monitoring.

Choice D rationale

Liver enzymes, such as ALT (normal range: 7-56 U/L) and AST (normal range: 10-40 U/L), are crucial to assess for a client taking valproate. This medication is hepatically metabolized and can cause dose-related transient elevations or, rarely, severe, potentially fatal hepatotoxicity, necessitating regular monitoring of liver function.

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A nurse is developing a plan of care for a client who has COPD. The nurse should include which of the following interventions in the plan?

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A nurse is developing a plan of care for a client who has COPD.
The nurse should include which of the following interventions in the plan?