The nurse identifies the nursing diagnosis of imbalanced nutrition: less than body requirements for a patient with COPD.
An appropriate intervention for this problem would be:
Offer frequent small high calorie meals and snacks.
Increase the patient's intake of fruits and fruit juices.
Have the patient exercise for 10 minutes before meals.
Assist the patient in choosing foods with a lot of texture.
The Correct Answer is A
Choice A rationale
Patients with COPD often experience dyspnea while eating and early satiety due to the downward pressure of the diaphragm on the stomach. Providing frequent, small, high-calorie, and high-protein meals reduces the work of breathing associated with digestion and prevents the exhaustion often seen with large meals. High-density calories help counteract the increased metabolic demand caused by the excessive energy expenditure required for labored breathing, thereby supporting weight maintenance and muscle mass preservation.
Choice B rationale
While fruits and fruit juices provide essential vitamins and minerals, they may not provide the dense caloric or protein content required for a patient with COPD who is losing weight. Additionally, certain juices can cause gas or bloating, which further restricts diaphragmatic movement and increases respiratory discomfort. The focus for a patient with imbalanced nutrition in COPD must be on macronutrients that provide sustained energy and support respiratory muscle strength rather than just hydration and vitamins.
Choice C rationale
Exercise immediately before meals is contraindicated for patients with COPD because it increases dyspnea and fatigue, making it significantly harder for the patient to consume an adequate amount of food. Resting for at least 30 minutes prior to eating is the standard recommendation. This rest period allows the respiratory rate to stabilize and reduces the physical effort required for chewing and swallowing, which ensures the patient has enough energy to finish their prescribed meal.
Choice D rationale
Foods with a lot of texture, such as tough meats or dry crackers, require extensive chewing, which can lead to increased fatigue and shortness of breath during meals. For a COPD patient, softer foods that are easy to chew and swallow are preferred to minimize physical exertion. Choosing energy-dense, easy-to-consume foods helps the patient maintain adequate nutritional intake without the risk of respiratory exhaustion or choking during the process of eating.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Nonrebreather masks are designed to deliver high concentrations of oxygen, typically ranging from 60 percent to 90 percent, at flow rates of 10 to 15 liters per minute. This makes them high-flow delivery systems rather than low-flow systems like nasal cannulas. Using them for low-flow purposes would be ineffective and potentially dangerous, as the high flow is necessary to keep the reservoir bag inflated and ensure the patient receives the intended high oxygen concentration.
Choice B rationale
A nonrebreather mask is a large, tight-fitting device that covers both the nose and mouth to maintain high oxygen concentrations. It must be removed for the client to eat or drink, which poses a risk for desaturation during meals. In clinical practice, a nurse might temporarily switch a client to a nasal cannula during mealtime if tolerated, but the mask itself cannot remain in place while the client is consuming food or liquids.
Choice C rationale
The reservoir bag of a nonrebreather mask should never completely collapse. It is designed to remain partially inflated (one-third to one-half full) during inhalation to provide a continuous source of high-concentration oxygen. If the bag collapses during exhalation or inhalation, it indicates that the oxygen flow rate is set too low or there is a leak. Proper function requires a flow rate high enough to keep the reservoir bag adequately filled at all times.
Choice D rationale
A snug fit is essential for a nonrebreather mask to function correctly as a high-concentration delivery system. The mask features one-way valves that prevent room air from entering during inhalation and prevent exhaled air from returning to the reservoir bag. If the mask is loose, room air will dilute the oxygen, significantly decreasing the inspired oxygen fraction. Proper positioning over the nose and mouth ensures the client receives the maximum prescribed therapeutic oxygen level.
Correct Answer is D
Explanation
Choice A rationale
Budesonide is an inhaled corticosteroid that functions by reducing airway inflammation and stabilizing lysosomal membranes. However, its onset of action is relatively slow, taking several hours to days to reach therapeutic effectiveness. In an acute asthma exacerbation, immediate relief of bronchospasm is required. Therefore, budesonide is categorized as a maintenance medication for long-term control rather than a rescue medication for rapid symptom reversal during a sudden respiratory crisis.
Choice B rationale
Montelukast is a leukotriene receptor antagonist that blocks the action of cysteinyl leukotrienes, which are potent inflammatory mediators in the lungs. While it helps prevent bronchoconstriction and mucus production over time, it is administered orally and has a delayed onset of action. It is not indicated for the treatment of acute asthma attacks because it cannot provide the rapid bronchodilation necessary to open the airways and improve oxygenation during a severe symptomatic episode.
Choice C rationale
Tiotropium is a long-acting muscarinic antagonist that works by inhibiting acetylcholine receptors in the bronchial smooth muscle. This leads to prolonged bronchodilation, typically lasting 24 hours. Because it is a long-acting agent, it does not provide the immediate relief needed during an acute asthma exacerbation. Tiotropium is primarily used for the maintenance treatment of chronic obstructive pulmonary disease and persistent asthma to prevent future exacerbations rather than treating current ones.
Choice D rationale
Albuterol is a short-acting beta-agonist that works by stimulating beta-adrenergic receptors in the lungs, leading to rapid relaxation of bronchial smooth muscle and subsequent bronchodilation. When administered via a jet nebulizer, it provides quick relief of acute symptoms like wheezing and shortness of breath. This makes it the gold standard for treating acute asthma exacerbations, as it acts within minutes to increase airflow and reduce the work of breathing during a crisis.
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