A client with chronic obstructive pulmonary disease (COPD) has a ...

[jilianpiloj]

A client with chronic obstructive pulmonary disease (COPD) has a pulse oximetry reading of 93, increased red blood and white blood cell count, temperature of 101F, pulse 100, respirations 35, and a chest x-ray that showed a flattened diaphragm
 
  with infiltrates. Which of the following orders would the nurse be concerned about for this client? 1. Antibiotic therapy
   2. Oxygen by nasal cannula at 34 liters/minute
   3. Bronchodilators such as an adrenergic stimulating drugs or anticholinergic agents
   4. Nonsteroidal anti-inflammatory agents

Question 2

During an assessment to determine whether a client has a good sleep pattern, the nurse should be aware of a behaviorally defined assessment that includes which of the following?
 
  1. Observation of alertness during sedentary, repetitive activities
   2. Noting the ability to fall asleep within 1 hour
   3. Noting the final awakening at the habitual sleeping time
   4. Videotaping movement during sleep

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Answer to Question 1

2. Oxygen by nasal cannula at 3  4 liters/minute

Rationale:
The nurse should be concerned about the order for oxygen to be provided at 3-4 liters/minute. This amount of oxygen is too much for a client with COPD because the client's breaths are stimulated by a hypoxic drive and this disease process causes the body to retain carbon dioxide. Providing this much oxygen can result in an increase in carbon dioxide levels, leading to respiratory failure. Oxygen for this client should be at a lower rate, such as 12 liters/minute, with close assessments of the client's breathing status. The order for antibiotic therapy is expected since the client is febrile with an increase in white blood cells. Bronchodilators will keep the alveoli open and increase exchange of oxygen and carbon dioxide more effectively and would be expected for this client. Nonsteroidal anti-inflammatory agents are commonly ordered to decrease the inflammation and swelling of lung tissues to maximize oxygen and carbon dioxide exchange and to improve symptoms and would be expected for this client.

Answer to Question 2

1. Observation of alertness during sedentary, repetitive activities

Rationale:
Behavioral assessment includes observation of alertness during sedentary, repetitive activities. It notes the ability to fall asleep within 1030 minutes, not 1 hour. It notes the final awakening at the habitual rising time, not sleepling time, and uses the photographic serializing of movement during sleep, not videotaping.

[jilianpiloj]

Both answers were spot on, thank you once again

[Awesome]

Great! Please up vote