A patient who has a history of chronic obstructive pulmonary disease (COPD) was hospitalized for increasing shortness of breath and chronic hypoxemia (SaO₂ levels of 89% to 90%). In planning for discharge, which action by the nurse will be most effective in improving compliance with discharge teaching?

Correct Answer: C

Rationale: The correct answer is C - Arrange for the patient's caregiver to be present during the teaching. In the context of a patient with COPD, involving the caregiver in the discharge teaching is crucial for several reasons. COPD is a chronic condition that requires ongoing management and lifestyle modifications. By having the caregiver present, the patient is more likely to receive consistent support and reinforcement of the information provided during the teaching session. This support can help the patient adhere to the prescribed treatment plan, medication regimen, and lifestyle changes, ultimately improving compliance and health outcomes. Option A, having the patient repeat the instructions immediately after teaching, may not be as effective in the case of a chronic condition like COPD where ongoing support is crucial. Option B, accomplishing patient teaching just before discharge, may not allow enough time for the patient and caregiver to fully understand and internalize the information provided. Option D, starting discharge teaching during the admission process, may not be as effective as involving the caregiver who will be providing support post-discharge. In an educational context, this question highlights the importance of considering the holistic needs of patients with chronic conditions like COPD. It emphasizes the role of caregivers in supporting patient education and self-management, promoting better health outcomes and improved compliance with treatment plans.

Correct Answer: C

Rationale: The correct answer is C: Arrange for a daily meal and drug administration at a community center. This option is the most effective intervention as it addresses the patient's barriers to adherence, such as homelessness and potential lack of resources for meals. By providing both meals and medication administration at a community center, the nurse ensures that the patient has access to a safe and consistent environment for taking their medications. This approach also allows for directly observed therapy (DOT), which is crucial in the treatment of active TB to ensure medication compliance and reduce the risk of developing drug-resistant strains. Option A is incorrect as simply repeating warnings about infecting others does not address the patient's specific needs related to homelessness and substance abuse. Option B, giving written instructions, may not be effective for a patient who may have difficulty reading or understanding written information due to their circumstances. Option D, arranging for a friend to administer medication, may not be feasible or sustainable in the long term and does not address the underlying issues of homelessness and lack of resources. In an educational context, this question highlights the importance of considering social determinants of health and individual patient circumstances when planning interventions to promote treatment adherence. It emphasizes the need for holistic and patient-centered care, especially in vulnerable populations like the homeless with complex health needs. Nurses must be able to identify barriers to adherence and tailor interventions to address these barriers effectively to ensure optimal patient outcomes.

Correct Answer: D

Rationale: In this scenario, the correct action for the nurse to take first is to elevate the head of the bed to a semi-Fowler's position (Option D). Elevating the head of the bed helps improve the patient's breathing by reducing the work of breathing and enhancing oxygenation. This position promotes better lung expansion and perfusion, which can alleviate some of the symptoms the patient is experiencing, such as chest pain and difficulty breathing. It is a simple and immediate intervention that can be done at the bedside to provide relief while further diagnostic and treatment measures are initiated. Administering anticoagulant drug therapy (Option A) is an essential intervention for pulmonary embolism, but it is not the first action to take in this case. Stabilizing the patient's respiratory status should take precedence. Notifying the patient's health care provider (Option B) is important, but it is not the most urgent action to address the patient's acute distress. Immediate interventions to support oxygenation and perfusion should be prioritized. Preparing the patient for a spiral computed tomography (CT) scan (Option C) is a diagnostic measure that may be necessary to confirm the diagnosis of pulmonary embolism. However, in this acute situation where the patient is experiencing distress, the priority is to address the patient's breathing difficulties and chest pain first before proceeding with diagnostic tests. In an educational context, it is crucial for nurses to prioritize interventions based on the patient's presenting symptoms and immediate needs. Understanding the rationale behind each action and prioritizing care based on the patient's condition is essential for providing safe and effective nursing care, especially in critical situations like pulmonary embolism.

Correct Answer: C

Rationale: In this scenario, option C is the correct answer because cimetidine inhibits the metabolism of theophylline, leading to increased levels of theophylline in the body and potential toxicity. Therefore, consulting with the healthcare provider is essential to avoid adverse effects. Option A is incorrect because weight gain is not directly related to theophylline administration in COPD patients. Option B is incorrect as the absence of shortness of breath does not specifically impact theophylline administration. Option D is also incorrect as coughing up green mucus may indicate an infection but does not directly affect theophylline therapy. Educationally, understanding drug interactions is crucial for nurses to ensure safe and effective patient care. This question highlights the importance of recognizing potential interactions and the need for interprofessional collaboration in managing patients with complex medication regimens, such as those with COPD. Nurses must be vigilant in assessing all aspects of a patient's history to provide optimal care and prevent complications.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Self-administration of inhaled corticosteroids. Asthma management often involves the use of inhaled corticosteroids as they help reduce airway inflammation, a key component in asthma exacerbations. Educating the patient on how to properly use these medications is crucial for their effective management of the condition. Patients need to understand how to administer the medication correctly to ensure optimal drug delivery to the airways and to maximize its therapeutic effects. Option A, the use of long-acting β-adrenergic medications, is incorrect because while these medications are used in asthma management, inhaled corticosteroids are considered the first-line treatment for asthma as they target the underlying inflammation. Option B, side effects of sustained-release theophylline, is incorrect as theophylline is not commonly used in initial asthma management due to its narrow therapeutic index and potential for significant side effects. Inhaled corticosteroids are generally preferred over theophylline. Option D, complications associated with O₂ therapy, is incorrect as oxygen therapy is not typically a primary treatment for asthma. While it may be used in severe exacerbations, it is not a routine part of asthma management as inhaled corticosteroids are. Educationally, it is essential to emphasize the importance of patient education in asthma management. Proper inhaler technique, understanding medication schedules, recognizing and responding to asthma triggers, and knowing when to seek medical help are all vital components of self-management for individuals with asthma. By focusing on self-administration of inhaled corticosteroids in discharge teaching, the nurse can empower the patient to take an active role in managing their asthma effectively.