A nurse is reviewing discharge instructions with a client who has chronic obstructive pulmonary disease (COPD). Which of the following should the nurse include?

Correct Answer: C

Rationale: Rationale for Correct Answer (C): 1. Engaging in regular moderate exercise helps improve lung function and overall physical endurance in COPD patients. 2. Exercise can help strengthen respiratory muscles and reduce shortness of breath. 3. Regular exercise can also improve circulation and promote better oxygen delivery to tissues. Summary of Incorrect Choices: A. Avoiding fluid intake to reduce mucus production is incorrect as hydration is important for thinning mucus and preventing dehydration. B. Using a bronchodilator after exercising may be necessary, but it is not the most essential discharge instruction. D. Sleeping in a fully supine position is not recommended for COPD patients as it can worsen breathing difficulties.

Correct Answer: C

Rationale: The correct answer is C: To promote lung expansion. Placing the client in a semi-Fowler's position helps improve ventilation by allowing the lungs to expand more fully, aiding in gas exchange. This position also optimizes diaphragmatic function. A is incorrect because preventing atelectasis is more related to deep breathing exercises. B is incorrect as reducing pressure on the suture line is not the primary purpose of semi-Fowler's position. D is incorrect as preventing aspiration of secretions is not directly related to the positioning of a client recovering from a pneumonectomy.

Correct Answer: D

Rationale: The correct answer is D because postural drainage therapy helps mobilize and clear secretions from the bronchiectatic areas, reducing the risk of infection from stagnant sputum. It is a priority intervention to improve airway clearance and prevent further lung damage. Encouraging frequent coughing and deep breathing (A) may help clear secretions but may not be as effective as postural drainage. Increasing fluid intake (B) may help liquefy secretions, but without proper clearance, it may not address the underlying issue. Administering antibiotics (C) is important if there is an infection, but it does not directly address the need for sputum clearance in bronchiectasis.

Correct Answer: C

Rationale: The correct answer is C: Activated partial thromboplastin time (aPTT). Monitoring aPTT is essential for evaluating the effectiveness of heparin therapy because heparin primarily affects the intrinsic pathway of the coagulation cascade, which is reflected in the aPTT value. By monitoring aPTT levels, the nurse can ensure that the heparin dosage is within the therapeutic range to prevent clot formation without causing excessive bleeding. Platelet count (A) is important to monitor for heparin-induced thrombocytopenia but does not directly evaluate the effectiveness of heparin therapy. Prothrombin time (PT) (B) and International normalized ratio (INR) (D) are used to monitor warfarin therapy, which acts on the extrinsic pathway of the coagulation cascade, not heparin therapy.

Correct Answer: B

Rationale: The correct answer is B: To remove mucus from the airways. Postural drainage helps mobilize and clear mucus from the bronchiectatic airways, improving ventilation and reducing the risk of infection. This is crucial in bronchiectasis to prevent mucus buildup, which can lead to further lung damage and infections. Incorrect choices: A: To improve oxygen saturation - While postural drainage can indirectly improve oxygenation by clearing mucus, the primary goal is mucus clearance. C: To reduce inflammation in the lungs - Postural drainage primarily focuses on mucus clearance rather than reducing inflammation. D: To prevent respiratory infections - While mucus clearance can help prevent infections, the primary goal of postural drainage is to remove mucus.