The nurse is instructing a client with chronic insomnia
obstructive pulmonary disease how d to do rationale: The therapeutic range is 10 to 20
pursed lip breathing in which order should the mcg/mL. If level below therapeutic range, pt @
nurse explain the steps to the client? - risk for more frequent exacerbation s of disease
ANSWER -1. Relax your neck and shoulder
muscles
2. breathe in normally through your nose for two Which of the following indicates that the client
counts (while counting to yourself one, two) with COPD who has been discharged to home
3. pucker your lips as if you were going to whistle understands the care plan? - ANSWER -
4. Breathe out slowly through pursed lips for four The client agrees to call the position of dyspnea
counts (while counting to yourself one, two, on exertion increases
three, four) rationale: Increasing dyspnea on exertion
indicates that the client may be experiencing
complications of COPD. Therefore, the nurse
The nurse reviews in arterial blood gas report for should notify the physician. Extracting promises
a client with chronic obstructive pulmonary from clients is not an outcome criterion. Pain is
disease the results are: pH 7.35 PCO2 62 PO2 not a common symptoms of COPD. Clients with
70 HCO3 34. The nurse should first: - COPD use low flow oxygen supplementation 1 to
ANSWER -Assess the vital signs 2 L /minute to avoid suppressing the respiratory
rationale: client with chronic COPD CO2 drive, which, for these clients, and stimulated by
retention in the respiratory drive is stimulated hypoxia.
when the PO2 decreases. The heart rate,
respiratory rate, and blood pressure should be
evaluated to determine if the client is Which of the following physical assessment
hemodynamically stable. Symptoms such as findings are normal for a client with advanced
dyspnea should be assessed. COPD? - ANSWER -Increased
anteroposterior chest diameter (barrel chest)
rationale: Increased anteroposterior chest
When developing a discharge plan to manage diameter is characteristic of advanced COPD. Air
the care of a client with COPD the nurse should is trapped in the overextended alveoli in the ribs
advise the client to expect to: - ANSWER - are fixed in and inspiratory position. The result is
Develop respiratory infections easily the typical barrel chested appearance. Overly
rationale: A client with COPD is at high risk for developed not under developed neck muscles
development of respiratory infections. COPD is are associated with COPD because of their
slowly progressive; therefore, maintaining current increase use in the work of breathing. Distended,
status and establishing a goal that the client will not collapsed, neck veins are associated with
require less supplemental oxygen are unrealistic COPD as a symptom of the heart failure that the
expectations. client may experience secondary to the increased
workload on the heart to pump blood into the
pulmonary vasculature. Diminished, not
The client with COPD is taking theophylline the increased, chest excursion is associated with
nurse should instruct the client to report which of COPD.
the following signs of theophylline toxicity? -
ANSWER -Nausea
vomiting When instructing clients on how to decrease the
seizures risk of COPD the nurse should emphasize which
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