An 83-year old client diagnosed with COPD has been receiving 1L of oxygen via nasal cannula. When the relatives visited, the sister of the client increased the oxygen to 7L per minute because she says that the client "looks like he is having difficulty getting air." What should the nurse's initial action be?

Correct Answer: C

Rationale: Increasing the oxygen flow rate from 1L to 7L per minute without a healthcare provider's order is not safe for the client. High-flow oxygen can lead to oxygen toxicity, absorption atelectasis, and can reduce the respiratory drive in patients with COPD. The nurse's initial action should be to notify the physician about the change in oxygen delivery and the client's condition. The physician should reevaluate the client's oxygen requirements and provide appropriate orders based on the clinical assessment. It is crucial to follow evidence-based guidelines and healthcare provider orders for oxygen administration to ensure patient safety and optimal outcomes.

Correct Answer: B

Rationale: Canned tomato juice is often high in sodium content due to added salt during processing. Since Mr. Aurelio has been prescribed a 2 gm sodium diet, the nurse would instruct him to restrict foods high in sodium content, such as canned tomato juice. Whole wheat bread and apples are generally low in sodium, and beef tenderloin strips can be chosen in lean cuts and prepared without high sodium additives, making them more suitable for Mr. Aurelio's dietary restrictions.

Correct Answer: A

Rationale: Addisonian crisis, also known as acute adrenal crisis, is a life-threatening condition that occurs when there is a severe deficiency in cortisol and aldosterone hormones, usually resulting from adrenal gland insufficiency. In this situation, it is crucial to administer hydrocortisone (a synthetic form of cortisol) promptly to replace the lacking hormone. Potassium levels in individuals experiencing an Addisonian crisis can be elevated due to the lack of aldosterone, which normally helps regulate electrolyte levels such as potassium. Therefore, administering potassium chloride in this scenario can lead to further complications and exacerbate the existing electrolyte imbalance. In contrast, normal saline solution can help with fluid and electrolyte balance, and fludrocortisone can be administered to replace the deficient aldosterone.

Correct Answer: D

Rationale: Salicylates, such as aspirin, can potentiate the hypoglycemic effects of insulin. They can increase insulin sensitivity and potentially lead to low blood sugar levels (hypoglycemia). Therefore, clients using insulin should avoid over-the-counter salicylate preparations to prevent this interaction and the risk of hypoglycemia. It is important for clients to always consult healthcare professionals before taking any new medications or over-the-counter preparations when using insulin therapy.

Correct Answer: B

Rationale: For a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS), the correct statement is to administer 6L of IV fluid over the first 24 hours (option B). The management of HHNS focuses on correcting dehydration and hyperglycemia. The initial fluid resuscitation in HHNS aims to address the profound dehydration that occurs due to osmotic diuresis from hyperglycemia. The recommended rate is to administer 1 to 1.5 L/hour of IV fluid until the patient is hemodynamically stable and urine output is adequate. Administering fluid rapidly helps to address the hypovolemia and prevent complications associated with shock. Administering fluid too slowly may delay the correction of dehydration and lead to further complications.