The nurse and unlicensed assistive personnel (UAP) are caring for an elderly client diagnosed with emphysema. Which nursing tasks could be delegated to the UAP to improve gas exchange? (Select All that Apply)
Assess level of consciousness
Auscultate breath sounds
Encourage deep breathing exercises
Record pulse oximeter reading
Keep the head of bed elevated
Correct Answer : C,D,E
A. Assessing level of consciousness is a nursing responsibility and cannot be delegated to the UAP.
B. Auscultating breath sounds requires clinical judgment and must be performed by a nurse.
C. Encouraging deep breathing exercises is within the scope of a UAP and can help improve gas exchange.
D. Recording a pulse oximeter reading is a task that can be delegated to a UAP, though interpretation remains the nurse’s responsibility.
E. Keeping the head of the bed elevated helps improve oxygenation and can be done by the UAP.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Hypertension is not a direct risk factor for COPD. However, COPD and hypertension can coexist, especially in smokers.
B. Being male was once associated with a higher COPD prevalence, but COPD affects both sexes, especially as smoking habits have become more equal.
C. Alpha-1 Antitrypsin (AAT) deficiency is correct. AAT deficiency is a genetic disorder that leads to early-onset emphysema, even in non-smokers. It impairs the lungs' ability to protect themselves from enzymatic damage.
D. History of pulmonary embolism is not a primary risk factor for COPD, though lung damage from recurrent emboli can contribute to respiratory issues.
Correct Answer is A
Explanation
A. Orthopnea is correct. Left-sided heart failure causes pulmonary congestion, making it difficult for the client to breathe when lying flat. This results in orthopnea, where the client must sit up or use multiple pillows to breathe comfortably.
B. Bradycardia is incorrect. Heart failure typically leads to tachycardia due to the heart compensating for decreased cardiac output.
C. Diaphoresis is incorrect. While excessive sweating can occur in acute decompensated heart failure, it is not a hallmark symptom of left-sided heart failure.
D. Frequent coughing with yellow sputum is incorrect. A client with left-sided heart failure may have a dry or frothy, pink-tinged cough, but yellow sputum suggests infection rather than heart failure.
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