A nurse is planning care for a client who has COPD with dyspneic episodes. Which of the following interventions should the nurse include?

Instruct the client to perform coughing exercises after meals.

Limit the client's fluid intake to 1,500 mL/day.

Encourage the client to sit in a chair for 1 hr several times per day.

Initiate oxygen therapy for the client via nasal cannula at 10 L/min.

Answer and Explanation

The Correct Answer is A

A) Instruct the client to perform coughing exercises after meals.
Coughing exercises after meals can help clear the airways of mucus, which is beneficial for clients with COPD. Effective airway clearance is crucial to improve breathing and reduce the risk of infections. This intervention can enhance respiratory function and comfort.

B) Limit the client's fluid intake to 1,500 mL/day.
Limiting fluid intake is generally not recommended for clients with COPD unless there is a specific medical reason, such as heart failure. Adequate hydration helps keep mucus thin and easier to expectorate, which is important for respiratory health.

C) Encourage the client to sit in a chair for 1 hr several times per day.
Encouraging the client to sit in a chair helps promote mobility and prevent complications associated with prolonged bed rest. However, while sitting up can improve lung expansion, it is not the most specific or direct intervention to address dyspneic episodes.

D) Initiate oxygen therapy for the client via nasal cannula at 10 L/min.
Administering oxygen at a high flow rate like 10 L/min is not typically appropriate for clients with COPD due to the risk of depressing their respiratory drive. Oxygen therapy should be carefully titrated and monitored based on the client's needs and blood gas levels.

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Correct Answer is D

Explanation

A) "You should remain on a clear liquid diet for 1 week after surgery.": After a laparoscopic cholecystectomy, clients do not need to remain on a clear liquid diet for a week. They can usually progress to a regular diet as tolerated, starting with light meals and avoiding fatty, greasy foods initially to prevent discomfort.

B) "Avoid showering for 1 week after surgery.": Clients are typically allowed to shower within a day or two after surgery, as long as they avoid soaking the incisions in water and follow the healthcare provider's instructions for incision care. Avoiding showering for a week is generally unnecessary and may hinder hygiene.

C) "Cleanse the incision sites with hydrogen peroxide.": Hydrogen peroxide can delay wound healing and is not recommended for routine incision care. The nurse should advise the client to cleanse the incision sites with mild soap and water and pat them dry.

D) "Apply heat to the right shoulder for pain.": Applying heat to the right shoulder can help relieve referred pain often experienced after a laparoscopic cholecystectomy due to residual gas used during the procedure. This is a common and effective method for managing postoperative discomfort.

A. Maintain the client on bed rest for 48 hr following surgery. B. Check the tubing for kinks and blood clots at least every 2 hr. C. Irrigate the client's bladder continuously using 5% dextrose in Ringer's lactate. D. Remove the catheter if the client reports severe bladder spasms.

Correct Answer is B

Explanation

A) Maintain the client on bed rest for 48 hr following surgery: While some bed rest is recommended initially post-surgery, maintaining bed rest for 48 hours is excessive and can increase the risk of complications like deep vein thrombosis. Early mobilization is generally encouraged to enhance recovery.

B) Check the tubing for kinks and blood clots at least every 2 hr: Regularly checking the catheter tubing for kinks and blood clots is essential to ensure the continuous flow of urine and prevent catheter blockage. This can help in reducing the risk of complications such as bladder distension and urinary retention.

C) Irrigate the client's bladder continuously using 5% dextrose in Ringer's lactate: Continuous bladder irrigation is often done post-TURP to prevent clot formation, but 5% dextrose in Ringer's lactate is not the recommended solution. Typically, normal saline is used to minimize the risk of electrolyte imbalance and maintain the correct osmolarity.

D) Remove the catheter if the client reports severe bladder spasms: Severe bladder spasms can occur post-TURP, but removing the catheter is not the immediate solution. The catheter is necessary for drainage and should be managed with antispasmodic medications or adjusting the irrigation flow rather than removal.

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A nurse is planning care for a client who has COPD with dyspneic episodes. Which of the following interventions should the nurse include?

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