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 C

Explanation

A) Decreased systolic blood pressure: In older adults, systolic blood pressure often increases due to stiffening of the arteries rather than decreasing. This increase in systolic blood pressure is due to reduced elasticity in blood vessels, making it a common physiological change.

B) Decreased anteroposterior chest diameter: In fact, the anteroposterior chest diameter often increases with age due to changes in the rib cage and spine, such as kyphosis. An increased chest diameter is observed in older adults, not a decrease.

C) Increased cerumen thickness: As people age, cerumen (earwax) production can increase and the cerumen can become thicker and drier. This is due to changes in the ceruminous glands and can lead to more frequent earwax impaction in older adults, making it a relevant point to include in the educational program.

D) Increased saliva production: Typically, older adults experience a decrease in saliva production, not an increase. Reduced saliva production can contribute to difficulties with chewing, swallowing, and oral health.

A. Evaluate the client's understanding of diabetes management. B. Administer potassium supplements. C. Initiate a continuous infusion of 0.9% sodium chloride. D. Chek for improvements in the client's level of consciousness.

Correct Answer is C

Explanation

A) Evaluate the client's understanding of diabetes management: While it is important to assess the client’s understanding of diabetes management to prevent future hyperglycemic episodes, this is not the immediate priority. The client's current hyperglycemic-hyperosmolar state needs urgent intervention to stabilize their condition before educational measures can be effective.

B) Administer potassium supplements: Potassium supplementation may be necessary, especially if the client is hypokalemic, but it is not the first action. Electrolyte levels should be monitored and corrected as part of the treatment, but the initial priority is to address the severe dehydration and hyperglycemia.

C) Initiate a continuous infusion of 0.9% sodium chloride: This is the most critical first step. Clients in a hyperglycemic-hyperosmolar state are typically severely dehydrated due to osmotic diuresis. Initiating a continuous infusion of isotonic saline helps to restore intravascular volume, improve perfusion, and stabilize hemodynamics, which is essential before addressing other issues.

D) Check for improvements in the client's level of consciousness: Monitoring the client's level of consciousness is important as it provides information about their neurological status and response to treatment. However, this is a subsequent action after initiating fluid resuscitation, which directly addresses the immediate life-threatening aspects of the hyperglycemic-hyperosmolar state.

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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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