A client has a great deal of pain when coughing and deep breathing after abdominal surgery despite having pain medication. What action by the nurse is best?

Correct Answer: B

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: A

Rationale: Lung cancer risk in smokers is heavily influenced by the age of smoking initiation, with earlier exposure amplifying cumulative damage to lung tissue. Starting young extends the duration of carcinogen exposure (e.g., polycyclic aromatic hydrocarbons), increasing DNA mutations and oncogenic potential, as evidenced by higher incidence in lifelong smokers who began in adolescence. Risk does decrease after cessation dropping significantly within 10-15 years contradicting the notion of permanent risk or mandatory annual X-rays, which aren't standard for all ex-smokers. Cigarette type (e.g., tar, nicotine levels) matters, but pack-years and initiation age outweigh this factor. Other risk factors (e.g., radon, genetics) contribute but are secondary to smoking's dose-dependent effect. The nurse's accurate response educates students on the preventable, time-sensitive nature of this risk, reinforcing cessation's protective impact.

Correct Answer: D

Rationale: Small cell lung cancer (SCLC) is rarely treated with surgery because it grows rapidly and metastasizes early and extensively, often presenting with distant spread (e.g., brain, bones) by diagnosis. Unlike non-small cell lung cancer (NSCLC), where surgery suits localized disease, SCLC's aggressive neuroendocrine nature drives early dissemination, rendering resection ineffective as a primary cure. Cell size doesn't limit visualization surgical feasibility hinges on containment, not microscopy. SCLC isn't self-limiting; it's fatal without treatment, progressing quickly, not delaying intervention. Patient stability varies, but surgery's exclusion stems from tumor behavior, not universal frailty. The nurse's response, rooted in SCLC's biology, clarifies why chemotherapy and radiation systemic therapies are standard, aligning with guidelines (e.g., NCCN) and helping the patient understand his treatment plan.

Correct Answer: C

Rationale: Bronchiectasis involves chronic, irreversible dilation of bronchi and bronchioles from repeated inflammation or infection, destroying muscle and elastic tissue. This widening traps mucus, fostering recurrent infections and obstruction, leading to respiratory difficulties like chronic cough and dyspnea. Acute bronchospasm, tightening of airways, is asthma's hallmark, not bronchiectasis's structural damage. Alveolar distention and impaired diffusion occur in emphysema, affecting gas exchange at the alveolar level, not bronchial dilation. Excessive gas exchange isn't a feature bronchiectasis reduces effective ventilation. The student nurse's recognition of this pathophysiology confirmed by imaging (e.g., CT showing bronchial widening) prepares them to anticipate copious sputum and infection risk, guiding care like chest physiotherapy to manage this distinct airway disease.

Correct Answer: B

Rationale: Severe arthritis in the hands precludes safe, effective metered-dose inhaler (MDI) use in a COPD patient, as it impairs the dexterity needed to press the canister and coordinate inhalation critical for drug delivery to the lungs. Poor technique reduces efficacy of bronchodilators or corticosteroids, worsening dyspnea. Ongoing smoking doesn't affect MDI mechanics, though it harms prognosis. Requiring both corticosteroids and beta2-agonists is common in COPD, manageable with separate or combined MDIs, not precluding use. Cataracts impair vision but not hand function; spacers can aid if technique falters. The nurse's recognition of arthritis prompts alternatives (e.g., nebulizers), ensuring medication delivery despite physical limitations, per COPD device selection principles.