An adult client, a smoker, has had chronic obstructive pulmonary disease (COPD) for twelve years. When conducting discharge teaching, what should the nurse advise the client to avoid in order to prevent exacerbation of COPD?

Exposure to persons with pneumonia or chickenpox.

Excessive physical exertion and respiratory tract infections.

Overdose of albuterol and alcohol consumption.

Excessive bedrest and lack of exercise.

Answer and Explanation

The Correct Answer is B

Choice A reason: Exposure to persons with pneumonia or chickenpox is not a good idea for anyone, but it is not the main factor that can worsen COPD. COPD is a chronic inflammatory condition that affects the airways and the lungs, and it is mainly caused by smoking or other environmental irritants. Pneumonia and chickenpox are acute infections that can affect the respiratory system, but they are not the primary cause of COPD exacerbation.

Choice B reason: Excessive physical exertion and respiratory tract infections are the most common triggers that can lead to COPD exacerbation, which is a sudden worsening of symptoms, such as shortness of breath, cough, and mucus production. Physical exertion can increase the oxygen demand and the work of breathing, while respiratory infections can cause inflammation and mucus obstruction in the airways. Therefore, the nurse should advise the client to avoid these factors and to seek medical attention if they occur.

Choice C reason: Overdose of albuterol and alcohol consumption are not recommended for anyone, but they are not the main factors that can aggravate COPD. Albuterol is a bronchodilator that can help relax the muscles around the airways and improve breathing, but it can also cause side effects, such as palpitations, tremors, and anxiety, if taken in excess. Alcohol consumption can impair the immune system and the liver function, but it does not directly affect the lungs or the airways.

Choice D reason: Excessive bedrest and lack of exercise are not beneficial for anyone, but they are not the main factors that can exacerbate COPD. Bedrest can lead to muscle weakness and deconditioning, while lack of exercise can reduce the cardiovascular and respiratory fitness. However, these factors do not cause inflammation or obstruction in the airways, which are the main features of COPD. The nurse should encourage the client to maintain a moderate level of physical activity and to follow a pulmonary rehabilitation program if available.

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Correct Answer is A

Explanation

Choice A reason: Providing the first medication prescribed for pain management is the best intervention that the nurse can implement first, because it can prevent the escalation of pain and reduce the need for higher doses later. The nurse should follow the principles of pain management, such as administering analgesics before pain becomes severe, using a multimodal approach, and individualizing the plan of care.

Choice B reason: Reviewing medical records to obtain pain tolerance expectations is not a priority intervention that the nurse should implement first, because it may not reflect the current pain level or needs of the client. Pain tolerance is influenced by many factors, such as culture, age, gender, and previous experiences, and it may vary from person to person and from situation to situation.

Choice C reason: Waiting until the client is awake before providing pain management is not a recommended intervention that the nurse should implement first, because it can lead to inadequate pain relief and delayed recovery. The nurse should not assume that the client is not in pain because of sedation, but should use other indicators, such as vital signs, facial expressions, and body movements, to assess pain.

Choice D reason: Attempting to obtain a self-report of pain level from the client is not a feasible intervention that the nurse should implement first, because the client may not be able to respond due to sedation. The nurse should use a valid and reliable pain assessment tool that is appropriate for the client's condition, such as the Behavioral Pain Scale (BPS) or the Critical-Care Pain Observation Tool (CPOT), to measure pain.

A. Log roll the client and place adult disposable briefs beneath the client. B. Maintain traction while the client uses a urinal. C. Release the traction so the client can use a bedpan. D. Insert an indwelling urinary catheter preoperatively.

Correct Answer is B

Explanation

Choice A reason: Log rolling the client and placing adult disposable briefs beneath the client is not a correct intervention, as it can cause displacement or misalignment of the fracture, which can lead to complications, such as delayed healing, nerve damage, or infection. Log rolling is a technique that involves moving the client as a unit, without twisting or bending the spine. Adult disposable briefs are absorbent pads that can be worn to manage urinary incontinence.

Choice B reason: Maintaining traction while the client uses a urinal is the correct intervention, as it can prevent the disruption of the fracture stabilization and allow the client to void comfortably and safely. Traction is a force that is applied to the fractured bone to reduce, align, and immobilize it. A urinal is a container that can be used to collect urine from the client, without requiring the client to get out of bed or change position.

Choice C reason: Releasing the traction so the client can use a bedpan is not a correct intervention, as it can compromise the fracture reduction and alignment, and cause pain and discomfort to the client. A bedpan is a shallow vessel that can be used to collect urine or feces from the client, by placing it under the client's buttocks. Releasing the traction can also increase the risk of bleeding, swelling, or infection.

Choice D reason: Inserting an indwelling urinary catheter preoperatively is not a necessary intervention, unless the client has urinary retention, obstruction, or infection. An indwelling urinary catheter is a tube that is inserted into the bladder through the urethra, and attached to a drainage bag. An indwelling urinary catheter can pose risks of trauma, infection, or bladder spasms, and should be avoided unless indicated.

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An adult client, a smoker, has had chronic obstructive pulmonary disease (COPD) for twelve years. When conducting discharge teaching, what should the nurse advise the client to avoid in order to prevent exacerbation of COPD?

Nursing Test Bank

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