A nurse is providing discharge teaching for a client with COPD. When teaching the client about breathing exercises, what should the nurse include in the teaching?

Correct Answer: C

Rationale: For a COPD client, diaphragmatic breathing is a key exercise to include in discharge teaching, retraining the patient to use the diaphragm over accessory muscles. This technique inhaling to expand the abdomen, exhaling to contract it reduces respiratory rate, enhances alveolar ventilation, and eases dyspnea by countering the shallow, rapid breathing typical in COPD's hyperinflated state. Lying supine restricts diaphragm movement, worsening air trapping. Pursed-lip breathing, far from avoided, slows expiration, preventing airway collapse a complementary skill. Chest breathing relies on upper thorax muscles, inefficient in COPD. The nurse's teaching on diaphragmatic breathing demonstrated with hand placement (e.g., on abdomen) improves oxygenation and energy efficiency, vital for home management, per respiratory therapy evidence.

Correct Answer: B

Rationale: Warfarin, an anticoagulant, delays clotting, posing a bleeding risk in surgery, so the nurse should consult the physician about the INR to assess clotting status. INR measures prothrombin time, indicating warfarin's effect typically held 5-7 days pre-op to normalize (INR 1.0-1.5). Chest X-rays assess lungs, not clotting. BUN evaluates kidney function, unrelated to warfarin's impact. CBC provides general blood data, but INR specifically tracks anticoagulation reversal needs. This action ensures the surgical team adjusts warfarin safely, preventing intraoperative hemorrhage while balancing thromboembolism risks, aligning with preoperative protocols for anticoagulant management.

Correct Answer: C

Rationale: Recommending family inclusion in preoperative education eases anxiety for both patient and relatives by clarifying procedures and postoperative roles, like coaching exercises. Family understanding reduces patient stress, enhancing compliance with instructions. Excluding family or limiting them to the waiting room misses this support opportunity education benefits from their involvement. Requiring attendance overstates policy; it's ideal, not mandatory. The nurse's response fosters a collaborative environment, aligning with holistic care to prepare the patient and family for the surgical experience, reducing misunderstandings and improving outcomes.

Correct Answer: B

Rationale: Anesthesia lowers metabolism, reducing heat production and causing postoperative hypothermia (97°F) and shivering, as the body's thermoregulation is depressed. A gown alone or laminar flow contributes minimally in a short procedure like carpal tunnel repair. No open body cavity exists here unlike major surgeries so heat loss is limited. The nurse's recognition guides warming measures (e.g., blankets), aligning with recovery care to restore normothermia safely.

Correct Answer: D

Rationale: Personality development is influenced by factors like culture, environment, and social groups, which shape an individual's traits and behaviors over time. 'Nutrition,' is correct as the answer because it is not a direct determinant of personality, though it impacts physical health. Culture (Choice A) defines values and norms that mold personality, as seen in cross-cultural psychology studies. Group (Choice B) refers to social interactions, such as peer influence, which shape traits, per social learning theory by Albert Bandura. Environment (Choice C) encompasses upbringing and surroundings, critical in Erik Erikson's psychosocial development stages. Nutrition, while essential for brain development and overall health, lacks a direct link to personality traits like extroversion or conscientiousness in psychological models, unlike the other options. Its effects are more physiological than psychological, making D the factor least related to personality development, consistent with established theories focusing on social and environmental influences.