A nurse is teaching a client who has COPD about purse-lipped breathing. Which of the following statements should the nurse make?
"You should be flat on your back when you perform purse-lipped breathing"
"You should inhale through your nose and exhale through your mouth during purse-lipped breathing."
Your inspiration should be longer than expiration during purse-lipped breathing"
"You should cough forcefully during exhalation when you are purse-lipped breathing"
The Correct Answer is B
A. Pursed-lip breathing does not require a specific body position, but it is often more comfortable and effective when the patient is in a semi-Fowler’s position (elevated head of the bed) or sitting upright. Being flat on the back might actually make breathing more difficult for some patients with COPD.
B. The technique involves inhaling slowly through the nose and exhaling through pursed lips, which creates a slight resistance during expiration. This helps to keep the airways open longer, reduce airway collapse, and improve oxygen exchange. Proper inhalation and exhalation technique are key components of effective pursed-lip breathing.
C. In pursed-lip breathing, expiration should be longer than inspiration. The recommended pattern is to inhale slowly through the nose for about 2 counts and then exhale slowly through pursed lips for about 4 counts. The extended expiration phase helps to remove trapped air from the lungs and improves overall ventilation.
D. Coughing forcefully is not a part of pursed-lip breathing. Pursed-lip breathing focuses on controlled breathing to improve airflow and ease breathing. Coughing can be done separately if needed, but it is not a component of the pursed-lip breathing technique.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C"]
Explanation
A. Asking the client to read their identification bracelet can be additional verification steps, but it is not standard practice for all institutions
B. To point to the surgical site can be additional verification steps, but it is not standard practice for all institutions.
C. Using two acceptable client identifiers, such as the client's name and date of birth, to confirm the patient's identity.
D. It is important to verify that the surgical site has been marked, which is a critical step in preventing wrong-site surgery.
E. Asking the client to state the surgery being performed is a good practice as it involves the patient in their care and serves as a final verification of the correct procedure.
Correct Answer is C
Explanation
A. The correct actions to take include staying with the client for the first 15-30 minutes after starting the transfusion, not just the first 10 minutes, to monitor for any adverse reactions.
B. It is also crucial to use 0.9% sodium chloride solution, not 5% dextrose in water, to flush the transfusion tubing.
C. It is a standard practice to have two nurses check the blood unit label to verify the correct blood type and compatibility before administration.
D. The transfusion should not be rushed over 1 hour; instead, it should be administered over a period of 2-4 hours, depending on the patient's condition and the volume of PRBCs to be transfused.
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