A nurse is providing dietary teaching for a client who has chronic obstructive pulmonary disease. Which of the following instructions should the nurse include?
"Use a bronchodilator 1 hour before eating."
"Eat 3 large meals each day."
"Limit water intake with meals."
"Reduce protein intake."
None
None
The Correct Answer is C
A. Administration of a prescribed bronchodilator is typically recommended approximately 30 minutes prior to meals rather than 1 hour. This pharmacological timing helps reduce dyspnea and facilitates easier deglutition and mastication by improving airflow. Using it too early may result in the peak therapeutic effect tapering off before the client finishes the meal.
B. Consuming 3 large meals each day is contraindicated for clients with chronic obstructive pulmonary disease because a distended stomach can exert upward pressure on the diaphragm. This abdominal crowding significantly increases the work of breathing and leads to early satiety or respiratory distress. Clients are instead encouraged to eat 5 to 6 small, frequent, nutrient-dense meals.
C. The nurse should instruct the client to limit water or fluid intake during the actual mealtime to prevent premature gastric distention. Early fullness from fluids reduces the client’s ability to consume essential solid nutrients and calories required to support the increased metabolic demands of labored breathing. Fluids should be consumed between meals to maintain adequate hydration and thin secretions.
D. Reducing protein intake is inappropriate because these clients require high-protein and high-calorie diets to prevent muscle wasting and support the respiratory muscles. The metabolic cost of breathing in chronic obstructive pulmonary disease is significantly elevated, often leading to a state of malnutrition or cachexia. Protein is vital for tissue repair and maintaining the functional integrity of the diaphragm.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["0.8"]
Explanation
To calculate the amount of mL to administer, the nurse should use the following formula:
(mg ordered / mg available) x mL available = mL to administer
Substituting the values from the question, the nurse should do the following:
(100 mg / 250 mg) x 2 mL = 0.8 mL
Correct Answer is C
Explanation
Continuing to monitor the client is the appropriate action for the nurse to take, as a rise in the water seal chamber with client inspiration is a normal and expected finding. The water seal chamber acts as a one-way valve that allows air to exit from the pleural space and prevents air from entering. The water level in this chamber fluctuates with breathing, rising with inspiration and falling with expiration. This indicates that the chest tube system is functioning properly and that there is no air leak.
a) Immediately notifying the provider is not necessary, as a rise in the water seal chamber with client inspiration is not an abnormal or urgent finding. The nurse should only notify the provider if there are signs of complications, such as persistent bubbling in the water seal chamber, which indicates an air leak, or no fluctuation in the water level, which indicates an obstruction or resolution of pneumothorax.
b) Clamping the chest tube near the water seal is not advisable, as it can cause increased pressure in the pleural space and lead to tension pneumothorax. Clamping the chest tube should only be done for a brief period of time and under specific circumstances, such as changing the drainage system, assessing for an air leak, or preparing for chest tube removal.
d) Repositioning the client toward the left side is not helpful, as it does not affect the water level in the water seal chamber. The nurse should position the client according to their comfort and condition, and avoid placing them flat or on their affected side, as this can impair drainage and ventilation.
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