A nurse cares for a client with a 40-year smoking history wh...

A nurse cares for a client with a 40-year smoking history who is experiencing distended neck veins and dependent edema. Which pathophysiologic process should the nurse associate with these clinical manifestations?

A. Increased pulmonary pressure creating a higher workload on the right side of the heart.
B. Increased pulmonary inflammation of the bronchi and bronchioles.
C. Increased number and size of mucus glands producing large amounts of thick mucus.
D. Left ventricular hypertrophy creating a decrease in cardiac output.

Correct Answer: A

Rationale: Smoking can lead to pulmonary hypertension, causing cor pulmonale (right-sided heart failure). This results in increased pulmonary pressure, backing up blood into the right heart and peripheral venous system, leading to distended neck veins and edema. The other options describe different pathophysiological processes not directly linked to these symptoms.

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A nurse is teaching a client with cystic fibrosis (CF). Which statements should the nurse include in this client's teaching? (Select all that apply.)

A. Drink fluids with meals to stay hydrated.
B. Rest before meals to conserve energy.
C. Eat six small meals a day.
D. Eat high-fiber foods to promote gastric emptying.
E. Increase carbohydrate intake for energy.

Correct Answer: A,B,C

Rationale: Fluids should be avoided with meals to prevent bloating, resting before meals conserves energy, and six small meals reduce bloating. High-fiber foods can cause gas, worsening shortness of breath, and excessive carbohydrates increase carbon dioxide production, risking acidosis.

After teaching a client how to perform diaphragmatic breathing, the nurse assesses the client's understanding. Which action demonstrates that the client correctly understands the teaching?

A. The client lays on his or her side with knees bent.
B. The client places his or her hands on his or her abdomen.
C. The client lays in a prone position with his or her legs straight.
D. The client places his or her hands above his or her head.

Correct Answer: B

Rationale: To perform diaphragmatic breathing correctly, the client should place their hands on their abdomen to feel the rise and fall of the diaphragm. This type of breathing cannot be performed effectively while lying on the side, in a prone position, or with hands above the head.

A nurse cares for a client who is prescribed an intravenous prostacyclin agent. Which actions should the nurse take? (Select all that apply.)

A. Keep an intravenous line dedicated strictly to the infusion.
B. Teach the client that this medication increases pulmonary pressures.
C. Ensure that there is always a backup drug cassette available.
D. Start a large-bore peripheral intravenous line.
E. Use strict aseptic technique when using the drug delivery system.

Correct Answer: A,C,E

Rationale: Prostacyclin should be administered via a dedicated central venous catheter with strict aseptic technique to prevent infection. A backup cassette is essential due to risks of interruption. The medication decreases pulmonary pressures, and a central line, not peripheral, is used.

The nurse is caring for a client who is prescribed a long-acting beta2 agonist. The client states, 'The medication is too expensive to use every day. I only use my inhaler when I have an attack.' How should the nurse respond?

A. You are using the inhaler incorrectly. This medication should be taken daily.
B. If you avoid environmental stimuli, it will be okay to use the inhaler only for asthma attacks.
C. Tell me more about your fears related to feelings of breathlessness.
D. It is important to use this type of inhaler every day. Let's identify potential community services to help you.

Correct Answer: D

Rationale: Long-acting beta2 agonists are maintenance medications to prevent asthma attacks and should be used daily. Addressing the client's financial concerns by identifying community resources is the most effective response. Simply stating the inhaler is used incorrectly or exploring fears does not address the financial barrier.

A nurse cares for a client who tests positive for alpha1-antitrypsin (AAT) deficiency. The client asks, 'What does this mean?' How should the nurse respond?

A. Your children will be at high risk for the development of chronic obstructive pulmonary disease.
B. I will contact a genetic counselor to discuss your condition.
C. Your risk for chronic obstructive pulmonary disease is higher, especially if you smoke.
D. This is a recessive gene and should have no impact on your health.

Correct Answer: C

Rationale: AAT deficiency increases the risk of COPD, particularly in smokers. Clients with one allele produce enough AAT to prevent COPD unless exposed to irritants like smoke. The risk to children depends on the partner's AAT status, and contacting a genetic counselor is not the priority response.