A patient who is taking rifampin (Rifadin) for tuberculosis calls the clinic and reports having orange discolored urine and tears.
Which response by the nurse reflects accurate knowledge about the medication and the patient's illness?

Choice A rationale

Restricting fluid intake in clients with COPD can lead to thickened secretions, making them more difficult to expectorate. Adequate hydration (typically 2-3 liters per day unless contraindicated) is crucial for maintaining thin, mobile respiratory secretions, which facilitates mucociliary clearance and reduces the risk of mucus plugging and subsequent exacerbations. This restriction would hinder respiratory hygiene.

Choice B rationale

Clients with COPD often experience increased metabolic demands due to the effort of breathing and may be at risk for malnutrition and muscle wasting. A low-protein diet would be detrimental, as protein is essential for maintaining respiratory muscle strength, tissue repair, and immune function. A high-protein, high-calorie diet is often recommended to support their nutritional status and overall health.

Choice C rationale

Pursed-lip breathing is a technique that helps clients with COPD by increasing intrabronchial pressure, which prevents premature airway collapse during exhalation, particularly in those with emphysema. This prolongs exhalation, improves gas exchange by allowing more complete emptying of the lungs, reduces air trapping, and can alleviate dyspnea, improving ventilatory efficiency.

Choice D rationale

For clients with COPD, exercising and engaging in activities during early-morning hours can be problematic. This is often the time when respiratory secretions are most abundant and tenacious due to nocturnal accumulation. Engaging in strenuous activity then can exacerbate dyspnea and increase the risk of bronchospasm or fatigue, making later parts of the day often more suitable for activity.

Choice A rationale

Encouraging wide-grip utensils does not address homonymous hemianopsia, which is a visual field deficit. Wide-grip utensils are typically used for clients with motor deficits or grip issues, not visual field cuts. This action would not help the client locate food within their blind visual field.

Choice B rationale

Encouraging the client to use their right hand, which is typically affected by a right-sided stroke, would be counterproductive and likely lead to frustration and difficulty with self-feeding. The left side of the body is often weaker or paralyzed after a right-sided stroke.

Choice C rationale

Homonymous hemianopsia involves a loss of half of the visual field in both eyes, contralateral to the stroke. For a right-sided stroke, the client will have left homonymous hemianopsia, meaning they cannot see things on their left side. Reminding them to look for food on the left side of the tray helps compensate for this visual deficit by prompting them to scan their blind field.

Choice D rationale

Providing a nonskid mat addresses plate movement, which can be helpful for clients with tremors or coordination issues, but it does not directly address the visual field deficit of homonymous hemianopsia. The primary problem here is not the plate moving, but the client's inability to see part of the plate.