A patient with chronic obstructive pulmonary disease (COPD) is prescribed theophylline. Which finding would be most concerning?

Correct Answer: B

Rationale: The correct answer is B. A heart rate of 112 bpm is concerning in a patient taking theophylline because it can indicate theophylline toxicity, which can lead to serious cardiac arrhythmias. Theophylline has a narrow therapeutic index, and levels above 20 mcg/mL can be toxic. Nausea, vomiting, and mild hand tremors are common side effects of theophylline but are not typically indicative of toxicity. Monitoring the theophylline level is important, but a level of 15 mcg/mL alone does not indicate toxicity. In summary, the elevated heart rate is the most concerning finding as it suggests potential theophylline toxicity, while the other options are more commonly seen as side effects without indicating toxicity.

Correct Answer: A

Rationale: The correct answer is A: Encourage the patient to drink at least 2 liters of water daily. This intervention promotes hydration, which helps to liquefy thick respiratory secretions, making them easier to expectorate. Drinking adequate water also maintains mucous membrane hydration. Option B (mucolytics) may be prescribed but may not be as effective without sufficient hydration. Option C (suctioning) is invasive and should be done cautiously to prevent mucosal damage. Option D (chest physiotherapy) helps with secretion mobilization but may not be as directly effective as hydration in liquefying secretions. In summary, promoting hydration is the most effective and least invasive intervention for a patient with thick respiratory secretions.

Correct Answer: D

Rationale: The correct answer is D: Sleep with an extra pillow to elevate the head. Elevating the head can help reduce nighttime coughing by promoting better drainage of mucus and easing breathing. This position can also decrease the likelihood of reflux, which can worsen coughing. Option A (using a humidifier) may help with dry air but won't directly address the cough. Option B (increasing fluid intake) may worsen coughing by increasing the need to urinate. Option C (cough suppressant) should be used cautiously in chronic bronchitis as it can hinder mucus clearance.

Correct Answer: C

Rationale: Rationale: 1. Paradoxical chest movement indicates a serious condition like flail chest, causing impaired breathing. 2. Oxygen therapy is the priority to ensure adequate oxygenation and prevent respiratory distress. 3. Administering pain medication may mask symptoms and delay appropriate intervention. 4. Chest tube insertion may be needed but is not the immediate priority. 5. Positioning the patient on the affected side is not recommended as it can worsen respiratory distress. Summary: Oxygen therapy is crucial to address respiratory compromise in chest trauma with paradoxical chest movement, while other options may not directly address the underlying issue or could potentially delay appropriate care.

Correct Answer: B

Rationale: The correct answer is B, sitting upright with arms supported on an over-bed table. This position allows for better visualization of the thoracentesis site, facilitates proper needle insertion, and minimizes the risk of complications such as pneumothorax. High-Fowler's position with the left arm extended (choice A) may not provide adequate access to the pleural effusion. Supine with the head of the bed elevated 30 degrees (choice C) may not allow for proper drainage and visualization. Lying on the right side with the left arm elevated (choice D) is incorrect as it does not facilitate proper access to the pleural effusion site.