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) "Drink whole milk instead of skim milk": Whole milk contains higher levels of saturated fats compared to skim milk. For individuals with hyperlipidemia, it is advisable to reduce intake of saturated fats to help lower cholesterol levels and improve heart health. Drinking skim or low-fat milk is a healthier option to manage lipid levels.

B) "Limit saturated fat to 15 percent of total daily fat intake": The American Heart Association recommends that saturated fat intake should be limited to less than 7% of total daily calories for those managing hyperlipidemia. Limiting saturated fat to 15% is too high and can contribute to increased cholesterol levels, negatively impacting cardiovascular health.

C) "Select trans fats for daily fat intake": Trans fats are known to significantly raise LDL (bad) cholesterol levels and lower HDL (good) cholesterol, increasing the risk of heart disease. It is essential to avoid trans fats altogether in the diet, as they are detrimental to cardiovascular health.

D) "Replace red meat with fish three times per week": Replacing red meat with fish, especially fatty fish like salmon, mackerel, and sardines, can be beneficial for individuals with hyperlipidemia. Fish is a good source of omega-3 fatty acids, which can help lower triglyceride levels, reduce inflammation, and improve overall heart health. This dietary change supports better lipid management and reduces the risk of cardiovascular diseases.

A. Diarrhea B. Bradycardia C. Tinnitus D. Tetany

Correct Answer is D

Explanation

A) Diarrhea: Metabolic alkalosis is more likely to be associated with constipation rather than diarrhea. Diarrhea is typically a cause of metabolic acidosis due to the loss of bicarbonate in stool, rather than a result of metabolic alkalosis.

B) Bradycardia: Bradycardia is not a typical manifestation of metabolic alkalosis. Alkalosis can lead to arrhythmias, but it generally does not cause a slow heart rate. Instead, tachycardia might occur as the body compensates for the altered acid-base balance.

C) Tinnitus: Tinnitus is not a common symptom of metabolic alkalosis. It is more often associated with aspirin toxicity or other conditions affecting the auditory system, rather than changes in acid-base balance.

D) Tetany: Tetany is a common manifestation of metabolic alkalosis. The alkalosis causes a decrease in ionized calcium levels, which increases neuromuscular excitability and can lead to muscle cramps, spasms, and tetany. This is a key sign for nurses to monitor as it indicates significant electrolyte disturbances associated with the alkalotic state.

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