A nurse working in the respiratory unit is caring for a client admitted for end stage COPD. Upon assessment the client's skin is pink, respirations are 13 bpm and saturations are 92% on 6 liters via nasal cannula. The client is complaining of shortness of breath while laying down. What should be the nurse's first priority action?

Retake the vital signs.

Call the health care provider.

Place the client in Fowler's position.

Increase the oxygen rate.

Answer and Explanation

The Correct Answer is C

A) Retake the vital signs:
While taking vital signs is important, the client’s vital signs (respiratory rate of 13 bpm, oxygen saturation of 92%, and normal skin color) suggest that there is no immediate crisis, such as a sudden drop in oxygen saturation or significant hemodynamic instability. Therefore, retaking the vital signs would not address the most urgent issue at the moment, which is the client's shortness of breath while laying down.

B) Call the healthcare provider:
Calling the healthcare provider may eventually be necessary if the patient's condition worsens or remains unrelieved after interventions. However, the first priority should be to manage the client’s immediate symptoms and improve their comfort. The client’s complaint of shortness of breath when lying down suggests that the positioning may be a contributing factor to their discomfort.

C) Place the client in Fowler's position:
The most appropriate first action for a client with end-stage COPD and shortness of breath while lying down is to place the client in Fowler's position. This position (sitting upright, typically at a 45-60° angle) helps to improve lung expansion and reduce the workload of breathing by using gravity to assist in lung ventilation. It also promotes diaphragmatic breathing, which can relieve the feeling of breathlessness.

D) Increase the oxygen rate:
The client is already on 6 liters of oxygen via nasal cannula and has an oxygen saturation of 92%, which is within an acceptable range for a patient with COPD. Increasing the oxygen rate further could risk causing oxygen toxicity or lead to CO2 retention in clients with COPD, as their respiratory drive is often driven by low oxygen levels rather than high carbon dioxide levels. Thus, increasing the oxygen rate should be done cautiously and only if clinically indicated by a healthcare provider.

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Correct Answer is D

Explanation

A) Cyanosis:
Cyanosis, which is a bluish discoloration of the skin and mucous membranes, typically occurs with severe hypoxia or oxygen deprivation, usually when oxygen saturation levels drop below 85%. Cyanosis is a late sign of hypoxia, not an early sign. In the early stages of hypoxia, the body attempts to compensate, and cyanosis does not typically appear until oxygen levels are significantly low.

B) Hypotension:
While hypotension can be a consequence of severe or prolonged hypoxia, it is generally a late sign. In the early stages of hypoxia, the body compensates through mechanisms such as tachycardia and vasoconstriction, so hypotension would not be expected at this stage. Hypotension in a hypoxic patient usually signals progression to severe respiratory or circulatory failure.

C) Bradycardia:
Bradycardia (slow heart rate) is not typically associated with early hypoxia. Instead, the body tries to compensate for reduced oxygen levels by increasing heart rate (tachycardia) in the early stages. Bradycardia can occur in more severe stages of hypoxia, particularly if the body begins to struggle with compensating or if the patient progresses to a more critical state. However, it is not an early sign of hypoxia.

D) Tachycardia:
Tachycardia (an elevated heart rate) is an early compensatory mechanism that the body employs when oxygen levels are insufficient. The heart increases its rate to pump more blood (and thus oxygen) to vital organs and tissues. Tachycardia is one of the earliest signs of hypoxia and occurs as the body attempts to compensate for the decreased oxygen levels in the bloodstream.

A. 250 mg B. 25 mg C. 5 mg D. 200 mg

Correct Answer is B

Explanation

A. 250 mg:

This represents the amount of levodopa in the tablet, not carbidopa. Sinemet contains two active ingredients: carbidopa (25 mg) and levodopa (250 mg), as shown on the label.

B. 25 mg:

This is the correct answer, as the label indicates that each tablet contains 25 mg of carbidopa. Carbidopa is combined with levodopa to improve its effectiveness and reduce side effects like nausea.

C. 5 mg:

This is not accurate; the label clearly states that the carbidopa dose is 25 mg per tablet.

D. 200 mg:

This does not correspond to the dose of carbidopa or levodopa in this medication. The label specifies 25 mg of carbidopa and 250 mg of levodopa.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who has early symptoms of hypoxia. Which of the following findings should the nurse expect?

Correct Answer is D

Explanation

How many milligrams of carbidopa is this patient taking per dose/tablet?

Correct Answer is B

Explanation

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