A client is diagnosed with active tuberculosis and is started on medications. The nurse is aware that which parameter best indicates that the prescribed therapy has been effective? The client has: 

Choice A reason:
Using bronchodilators every 2 hours as needed may not be appropriate for all clients. Bronchodilators are typically used on a schedule or as needed based on symptoms, but overuse can lead to tolerance and decreased effectiveness. The nurse should provide education on the proper use and timing of bronchodilators.

Choice B reason:
Pursed-lip breathing is a technique that helps control shortness of breath and improve ventilation. It can slow down the client's breathing, promote relaxation, and ensure more effective lung function. This technique is particularly beneficial during an acute exacerbation of COPD and should be included in the discharge teaching plan.

Choice C reason:
Increasing home oxygen without proper assessment can be dangerous. Oxygen therapy should be titrated based on the client's oxygen saturation and clinical status. Clients with COPD are at risk of CO2 retention, and too much oxygen can suppress their drive to breathe. The nurse should educate the client on monitoring their SpO2 and when to adjust oxygen levels, typically under the guidance of a healthcare provider.

Choice D reason:
Huff coughing is a technique used to clear mucus from the airways. While it can be effective, it should be taught by a respiratory therapist or nurse who can assess the client's ability to perform the technique correctly. It is not the first-line teaching for a client being discharged with an acute exacerbation of COPD.

Choice A Reason
Intervening when a client attempts self-injury may be necessary to ensure the client's immediate safety. However, this action does not primarily implement the ethical principle of autonomy. Autonomy involves respecting the client's right to make their own decisions, including the right to refuse treatment. In cases of self-harm, the nurse must balance the ethical principles of autonomy and nonmaleficence (the duty to do no harm)

Choice B Reason
Suggesting restrictions for clients who were fighting might be a measure to maintain safety within the unit. However, this suggestion does not uphold the principle of autonomy, as it involves limiting the clients' freedom and choices. The ethical principle of autonomy emphasizes the clients' right to make independent choices and to control their own actions.

Choice C Reason
Staying with a client who is experiencing a high level of anxiety is a supportive action that can be therapeutic. While it demonstrates care and may provide comfort, it does not directly implement the principle of autonomy. Autonomy is about the capacity to make informed and voluntary decisions, and while support is important, it does not equate to enabling decision-making.

Choice D Reason
Exploring alternative solutions with a client and allowing them to choose an option embodies the ethical principle of autonomy. This approach respects the client's right to be involved in their own care and to make decisions based on their values and beliefs. It empowers the client to have control over their treatment and respects their capacity for self-determination.

In psychiatric nursing, respecting autonomy means acknowledging the client's right to make choices about their care and treatment. It involves providing all necessary information and supporting the client in making informed decisions. By exploring options and allowing the client to choose, the nurse facilitates autonomy and supports the client's right to direct their own care.