A nurse is preparing to administer 0.9 The nurse should set the IV pump to deliver how many ml/hr? (Round to the nearest whole number.

Use a leading zero if it applies.

Do not use a trailing zero.) . . .

Choice A rationale

Small, frequent meals reduce the metabolic and mechanical burden on the respiratory system. Large meals can cause gastric distension, which pushes the diaphragm upward, restricting lung expansion and increasing the work of breathing. By consuming smaller portions throughout the day, the client conserves energy and prevents the severe dyspnea often associated with the pressure of a full stomach against a compromised respiratory tract in chronic obstructive pulmonary disease.

Choice B rationale

High-fat diets are generally avoided as the primary caloric source in respiratory distress unless specifically ordered for low-carbohydrate needs. While fats are calorie-dense, excessive intake can lead to delayed gastric emptying and feelings of fullness that may exacerbate shortness of breath. The goal is a balanced intake that provides sufficient energy without causing abdominal discomfort or significantly increasing the metabolic rate beyond what the client's current oxygen supply can comfortably support for digestion.

Choice C rationale

Simple carbohydrates are metabolized quickly and result in the production of high levels of carbon dioxide as a byproduct. In clients with chronic obstructive pulmonary disease, the ability to exhale carbon dioxide is already impaired. Consuming high amounts of simple sugars can lead to hypercapnia, which increases the respiratory rate and worsens the sensation of fatigue and shortness of breath during and after mealtimes due to the increased ventilatory demand.

Choice D rationale

Eating a large meal late at night before sleeping is inappropriate for a client with respiratory compromise. Lying flat or sleeping shortly after a heavy meal increases the risk of acid reflux and aspiration. Furthermore, the pressure of a full stomach on the diaphragm is most pronounced when the client is in a recumbent position, which can lead to nocturnal dyspnea, poor sleep quality, and significant morning fatigue due to nighttime hypoxia.

Choice A rationale

Metabolic acidosis is characterized by a primary decrease in bicarbonate or an accumulation of nonvolatile acids in the blood. While patients with severe illness can develop multiple imbalances, the primary issue in COPD is not metabolic in origin. In metabolic acidosis, the lungs typically respond by hyperventilating to blow off carbon dioxide to raise the pH. This is the opposite of the hypoventilation and carbon dioxide retention typically seen in patients with chronic obstructive pulmonary disease.

Choice B rationale

Respiratory alkalosis occurs when there is excessive elimination of carbon dioxide from the lungs, usually due to hyperventilation. This leads to an increase in blood pH levels above 7.45. In a client with severe COPD, the primary physiological challenge is the inability to exhale carbon dioxide effectively due to air trapping and alveolar destruction. Therefore, these patients are much more likely to retain carbon dioxide rather than eliminate too much of it through the respiratory system.

Choice C rationale

Metabolic alkalosis involves a primary increase in bicarbonate levels or a loss of metabolic acids, leading to a blood pH greater than 7.45. This condition can be caused by factors like prolonged vomiting or excessive diuretic use. While some COPD patients on certain medications might experience metabolic shifts, it is not the classic acid-base imbalance associated with the underlying pathophysiology of obstructive lung disease and the resulting chronic failure of the respiratory pump to clear gas.

Choice D rationale

Respiratory acidosis is the hallmark of severe COPD due to chronic airflow obstruction and impaired gas exchange. The damaged alveoli and narrowed airways lead to the retention of carbon dioxide, which is a physiological acid. As carbon dioxide levels rise above the normal range of 35 to 45 mmHg, the blood pH drops below 7.35. This client’s report of dyspnea with minimal exertion suggests a high level of CO2 retention and a state of chronic respiratory acidosis.