A nurse is reinforcing teaching about self-management strategies with a client who has emphysema.
Which of the following client statements indicates that the client understands the instructions?

"I will drink about 34 ounces of fluid every day.”.

"I will inhale slowly through pursed lips to help me breathe better.”.

"I will follow a diet high in calories and protein.”.

"I will lie on my stomach to practice abdominal breathing every day.”. .

Answer and Explanation

The Correct Answer is C

The correct answer is choice C: “I will follow a diet high in calories and protein.”

Here are the rationales for each choice:

Choice A rationale: “I will drink about 34 ounces of fluid every day.” While staying hydrated is important for overall health, this statement does not specifically address a key self-management strategy for emphysema. Adequate fluid intake can help thin mucus, making it easier to expel, but it is not the most critical aspect of managing emphysema.

Choice B rationale: “I will inhale slowly through pursed lips to help me breathe better.” This statement is incorrect because the correct technique is to exhale through pursed lips, not inhale. Pursed-lip breathing helps to keep the airways open longer, reduce shortness of breath, and improve the exchange of oxygen and carbon dioxide.

Choice C rationale: “I will follow a diet high in calories and protein.” This is the correct answer. Emphysema can increase the body’s energy expenditure due to the effort required for breathing. A diet high in calories and protein helps maintain muscle mass and provides the necessary energy to support respiratory function.

Choice D rationale: “I will lie on my stomach to practice abdominal breathing every day.” This statement is not recommended for emphysema management. While abdominal or diaphragmatic breathing can be beneficial, lying on the stomach is not a typical position for practicing this technique. It is usually done while sitting or lying on the back.

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Correct Answer is D

Explanation

Choice A rationale:

A respiratory rate of 9/min and shallow respirations are indicative of hypoventilation, which can lead to an accumulation of carbon dioxide (CO2) in the blood. This condition results in respiratory acidosis (Choice D). In respiratory acidosis, the arterial pH is decreased (acidic) while the PaCO2 (partial pressure of carbon dioxide) is elevated.

Choice B rationale:

Respiratory alkalosis (Choice B) is characterized by a low PaCO2 and an elevated pH due to hyperventilation. Shallow respirations and a respiratory rate of 9/min do not align with this condition, as it typically involves rapid and deep breathing.

Choice C rationale:

Metabolic alkalosis (Choice C) results from a primary excess of bicarbonate (HCO3-) in the blood and is not associated with the given respiratory patterns. Shallow respirations and a low respiratory rate are more likely to lead to an accumulation of CO2, causing respiratory acidosis (Choice D).

Choice D rationale:

The correct answer is choice D. Shallow respirations and a respiratory rate of 9/min indicate hypoventilation, leading to an accumulation of CO2 in the blood. This condition results in respiratory acidosis, where the arterial pH is decreased. The body's compensatory response is to retain bicarbonate to normalize pH, but this can result in an elevated HCO3- level. The primary acid-base imbalance in this case is respiratory acidosis. .

A. "I will wear stockings with elastic tops.”. B. "I will avoid crossing my legs at the knees.”. C. "I will not go barefoot.”. D. "I will use a thermometer to check the temperature of my bath water.”. .

Correct Answer is A

Explanation

The correct answer is Choice A: "I will wear stockings with elastic tops."

Choice A rationale:

Wearing stockings with elastic tops can constrict blood flow in the legs, which is counterproductive for individuals with peripheral vascular disease. Compression stockings specifically designed for PVD are recommended, but these should be properly fitted and used according to medical advice.

Choice B rationale:

Avoiding crossing the legs at the knees is appropriate for individuals with PVD, as this can impede blood flow and worsen symptoms.

Choice C rationale:

Not going barefoot is important for clients with PVD, as it reduces the risk of injury and infection, which can be more serious due to compromised circulation.

Choice D rationale:

Using a thermometer to check the temperature of bath water is crucial for clients with PVD to avoid burns, since they may have decreased sensation in their extremities.

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A nurse is reinforcing teaching about self-management strategies with a client who has emphysema. Which of the following client statements indicates that the client understands the instructions?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is collecting data from a client who has shallow respirations and a respiratory rate of 9/min.Which of the following acid-base imbalances should the nurse expect?

Correct Answer is D

Explanation

A nurse is reinforcing teaching with a client who has peripheral vascular disease (PVD). The nurse should recognize that which of the following statements by the client indicates a need for further teaching?

Correct Answer is A

Explanation

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A nurse is reinforcing teaching about self-management strategies with a client who has emphysema.
Which of the following client statements indicates that the client understands the instructions?