An older adult patient has been diagnosed with COPD. What characteristic of the patients current health status would preclude the safe and effective use of a metered-dose inhaler (MDI)?

Correct Answer: B

Rationale: Severe arthritis in the hands precludes safe, effective metered-dose inhaler (MDI) use in a COPD patient, as it impairs the dexterity needed to press the canister and coordinate inhalation critical for drug delivery to the lungs. Poor technique reduces efficacy of bronchodilators or corticosteroids, worsening dyspnea. Ongoing smoking doesn't affect MDI mechanics, though it harms prognosis. Requiring both corticosteroids and beta2-agonists is common in COPD, manageable with separate or combined MDIs, not precluding use. Cataracts impair vision but not hand function; spacers can aid if technique falters. The nurse's recognition of arthritis prompts alternatives (e.g., nebulizers), ensuring medication delivery despite physical limitations, per COPD device selection principles.

Correct Answer: D

Rationale: Leg exercises prevent venous stasis and thrombus formation post-anesthesia by promoting circulation in the lower extremities. General anesthesia slows blood flow, and immobility reduces muscle contractions that pump venous blood, increasing clot risk. Exercises like ankle circles or calf pumps, done regularly, counteract this, reducing deep vein thrombosis odds. Coughing, diaphragmatic breathing, and incentive spirometry target lung expansion, preventing atelectasis, not circulatory stasis. The nurse's focus on leg exercises demonstrated pre- and postoperatively ensures blood flow, aligning with protocols to minimize thromboembolism, a significant postoperative risk.

Correct Answer: A

Rationale: A cup of coffee before a 7:30 surgery, breaching fasting guidelines (clear liquids 2-3 hours, solids 6-8 hours pre-anesthesia), risks aspiration, so the nurse anticipates a delay or cancellation. This protects airway safety during general or regional anesthesia. Coffee components (e.g., milk) might adjust delay length, but the breach itself triggers action. Asking 'why' or reviewing education, while useful later, isn't immediate. The nurse's report ensures the anesthesia provider adjusts timing e.g., delaying hours if milk was added prioritizing patient safety over proceeding, per fasting protocols.

Correct Answer: C

Rationale: Assessing intake and bladder distention is most appropriate, as anesthesia can delay urinary control 6-8 hours. Palpating for a full bladder and reviewing fluids (e.g., IVs) determines if retention exists, needing intervention like catheterization if distended. Waiting may work if non-distended, but assessment precedes. Immediate catheterization requires physician order post-assessment. Dismissing the feeling as universal ignores individual variation. This step ensures tailored care, preventing retention complications, per postoperative standards.

Correct Answer: D

Rationale: Defense mechanisms are unconscious strategies the mind uses to cope with anxiety or stress, protecting the ego from perceived threats. 'Defense mechanism,' is correct because avoidance (evading stress), displacement (redirecting emotions), fantasy (escaping into imagination), and projection (attributing feelings to others) are all classic examples identified by Sigmund Freud and Anna Freud in psychoanalytic theory. 'Ego,' is the part of the psyche that employs these mechanisms, not the mechanisms themselves. 'Super Ego,' is the moral conscience, not a set of coping strategies. 'Personality,' refers to broader behavioral patterns, not specific defense tactics. These mechanisms serve to manage internal conflicts, such as between the id's impulses and the super ego's standards, making D the accurate answer, rooted in Freudian psychology's explanation of how individuals unconsciously shield themselves from psychological distress.