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The nurse is teaching a client with chronic obstructive pulmonary disease who has been prescribed continuous oxygen therapy at home. Which statement indicates the client correctly understands the teaching?
- A. I will only use oxygen when I feel short of breath.
- B. I will store oxygen tanks in a warm, sunny area.
- C. I plan to use cotton balls to cushion the oxygen tubing on my ears.
- D. I will smoke while wearing my oxygen via nasal cannula.
Correct Answer: C
Rationale: Using cotton balls to cushion oxygen tubing prevents pressure ulcers, indicating correct understanding. Continuous oxygen should be worn at all times, not only when short of breath. Smoking while using oxygen poses a fire risk, and oxygen tanks should be stored in a cool, well-ventilated area.
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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.
A nurse cares for a client with chronic obstructive pulmonary disease (COPD). The client states that he no longer enjoys going out with his friends. How should the nurse respond?
- A. There are a variety of support groups for people who have COPD.
- B. I will ask your provider to prescribe an antianxiety agent.
- C. Friends can be a good support system for clients with chronic disorders.
- D. Encourage the client to participate in social activities.
Correct Answer: A
Rationale: Many clients with moderate to severe COPD become socially isolated due to embarrassment from frequent coughing and mucus production or fatigue. Suggesting a support group addresses this issue by connecting the client with others who share similar experiences. Antianxiety agents or encouraging social activities without addressing the underlying cause are less effective.
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.
A nurse is teaching a client who has cystic fibrosis (CF). Which statement should the nurse include in this client's teaching?
- A. Take an antibiotic each day.
- B. Contact your provider to obtain genetic screening.
- C. Eat a well-balanced, nutritious diet.
- D. Perform daily respiratory therapy exercises.
Correct Answer: C
Rationale: Clients with CF often experience malnourishment due to vitamin deficiency and pancreatic malfunction. A well-balanced, nutritious diet is essential for maintaining health. Daily antibiotics are not typically required, genetic screening is not relevant for management, and while respiratory therapy is important, it is not listed as an option.
A nurse assesses several clients who have a history of asthma. Which client should the nurse assess first?
- A. A 66-year-old client with a pulse oximetry reading of 91%
- B. A 60-year-old client with a barrel chest and clubbed fingernails
- C. A 35-year-old client who has a longer expiratory phase than inspiratory phase
- D. A 37-year-old client with a heart rate of 120 beats/min
Correct Answer: D
Rationale: Tachycardia can indicate hypoxemia as the body tries to circulate the oxygen that is available. A barrel chest is not an emergency finding. Likewise, a pulse oximetry level of 91% is not considered an acute finding. The expiratory phase is expected to be longer than the inspiratory phase in someone with airflow limitation.