A nurse is providing discharge teaching to a client who had an exacerbation of COPD. The client is prescribed a fluticasone by metered-dose inhaler. Which of the following instructions should the nurse include?

Use fluticasone as needed for shortness of breath.

Limit fluid intake to 1 L per day.

Avoid use of pursed-lip breathing.

Obtain a yearly influenza immunization.

Answer and Explanation

The Correct Answer is D

A. Use fluticasone as needed for shortness of breath: Fluticasone is a corticosteroid used for long-term inflammation control in COPD, not for immediate symptom relief. Short-acting bronchodilators like albuterol are used for acute shortness of breath.

B. Limit fluid intake to 1 L per day: COPD clients benefit from adequate hydration (typically 2-3 L per day) to help thin mucus secretions and improve airway clearance. Restricting fluids can lead to thickened secretions and increased respiratory distress.

C. Avoid use of pursed-lip breathing: Pursed-lip breathing is encouraged for COPD clients to help reduce air trapping, improve oxygenation, and promote more effective exhalation. It is an essential technique for managing dyspnea.

D. Obtain a yearly influenza immunization: COPD clients are at higher risk of complications from respiratory infections. An annual influenza vaccine helps reduce the risk of severe illness and exacerbations, making it a crucial part of COPD management.

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Correct Answer is C

Explanation

A. PO oxycodone: Oral medications are contraindicated in clients with paralytic ileus because of impaired gastrointestinal motility, which prevents proper absorption and increases the risk of gastric retention. IV administration is preferred for effective pain control in this scenario.

B. Ibuprofen via NG tube: NSAIDs can cause gastric irritation and increase the risk of gastrointestinal bleeding, especially in clients with pancreatitis. Additionally, an NG tube is not an appropriate route for medication administration in the presence of an ileus due to impaired intestinal function.

C. IV hydromorphone: IV opioids provide effective and rapid pain relief for clients with severe pain, especially when oral or enteral administration is not feasible. Hydromorphone is commonly used in acute pancreatitis because it controls pain effectively without exacerbating the underlying condition.

D. Topical lidocaine patch: While lidocaine patches provide localized pain relief, they are not sufficient for managing severe visceral pain associated with pancreatitis and ileus. Systemic analgesia via IV opioids is more appropriate for controlling this level of pain.

A. Constipation B. Peripheral neuropathy C. Mouth ulcers D. Decreased tear production

Correct Answer is C

Explanation

A. Constipation: Radiation therapy to the neck does not typically affect the gastrointestinal system directly. Constipation is more commonly associated with opioid pain management or radiation targeting the abdominal or pelvic region rather than the head and neck area.

B. Peripheral neuropathy: Nerve damage leading to peripheral neuropathy is more often linked to chemotherapy, particularly agents like vincristine or cisplatin, rather than radiation therapy. Radiation to the neck primarily affects tissues in the irradiated field, such as the oral mucosa.

C. Mouth ulcers: Radiation to the neck frequently causes mucositis, leading to painful mouth ulcers due to the direct impact on rapidly dividing mucosal cells. Clients may experience pain, difficulty swallowing, and increased risk of infection as a result of mucosal breakdown.

D. Decreased tear production: Radiation therapy to the neck is unlikely to directly affect the lacrimal glands. While radiation near the eyes can cause dry eyes, treatment focused on the neck primarily impacts the oral mucosa, salivary glands, and throat rather than tear production.

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A nurse is providing discharge teaching to a client who had an exacerbation of COPD. The client is prescribed a fluticasone by metered-dose inhaler. Which of the following instructions should the nurse include?

Nursing Test Bank

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A nurse is caring for a client who has developed a paralytic ileus related to acute pancreatitis and reports pain as 8 on a scale of 0 to 10. The client has prescriptions for multiple PRN pain medications. Which of the following medications should the nurse administer?

Correct Answer is C

Explanation

A nurse is planning care for a client who is receiving targeted radiation therapy to the neck. The nurse should plan to monitor the client for which of the following as an adverse effect of this therapy?

Correct Answer is C

Explanation

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