The nurse develops a teaching plan to help increase activity tolerance at home for an older adult with severe chronic obstructive pulmonary disease (COPD). Which instructions would be appropriate for the nurse to include in the plan of care?

Correct Answer: D

Rationale: Correct Answer: D Rationale: 1. Walking 15 to 20 minutes a day at least 3 times/week is appropriate for an older adult with severe COPD to gradually improve activity tolerance without overexertion. 2. Regular, moderate exercise can help improve cardiovascular function and lung capacity in COPD patients. 3. Consistent schedule of 3 times/week allows for adequate rest periods in between exercise sessions. Summary: A: Incorrect. Walking 15 to 20 minutes a day is more beneficial than just 3 times/week. B: Incorrect. Limiting exercise to ADLs may not provide enough physical activity to improve activity tolerance. C: Incorrect. Exceeding a pulse rate of 130 beats/minute may be too strenuous for an older adult with severe COPD.

Correct Answer: A

Rationale: The correct answer is A: Increase the oxygen flow rate. In COPD patients experiencing shortness of breath, ensuring adequate oxygenation is crucial. Step 1: Assess the patient's oxygen saturation levels. Step 2: If oxygen saturation is low, increasing the oxygen flow rate will help improve oxygenation. Step 3: Monitor the patient's response to the increased oxygen flow rate. Administering a nebulized bronchodilator (B) may also be beneficial but addressing hypoxemia is the priority. Monitoring respiratory status (C) is important but not the immediate action. Administering oxygen therapy (D) is vague and less specific than increasing oxygen flow rate.

Correct Answer: A

Rationale: The correct answer is A: Administer oxygen therapy. In CHF, shortness of breath is often due to inadequate oxygenation. Administering oxygen therapy helps improve oxygen levels, alleviating respiratory distress. Morphine (B) can depress respiratory drive, making the situation worse. Administering pain relief (C) is not the priority when the patient's breathing is compromised. Administering IV fluids (D) can worsen fluid overload in CHF, exacerbating symptoms. Overall, oxygen therapy directly addresses the patient's immediate need for improved oxygenation in CHF.

Correct Answer: A

Rationale: The correct answer is A: Administer aspirin. Aspirin is indicated as a priority action for a patient exhibiting facial drooping, as it may suggest the patient is experiencing a potential stroke. Aspirin helps prevent blood clot formation, which is crucial in ischemic strokes. Immediate administration of aspirin can help reduce the risk of further clot formation and minimize potential brain damage. Administering nitroglycerin (choice B) is not appropriate for stroke management. Short-acting bronchodilators (choice C) are not relevant to the patient's presentation. Administering antibiotics (choice D) is not indicated unless there is a specific infection present.

Correct Answer: D

Rationale: In the context of nursing, the assessment finding of bilateral basilar crackles in an older patient indicates the need for immediate action because it suggests significant respiratory issues such as pulmonary edema or infection. Prompt intervention is crucial to prevent further deterioration and ensure patient safety. Option A, weak cough effort, while concerning, does not pose an immediate threat to the patient's well-being. It may indicate muscle weakness or neurological issues but does not require urgent action like bilateral basilar crackles do. Option B, barrel-shaped chest, is a chronic finding commonly seen in patients with conditions like COPD. While it warrants monitoring and management, it does not necessitate immediate action as it is not an acute change in the patient's condition. Option C, dry mucous membranes, can indicate dehydration or inadequate fluid intake. While important to address, it does not pose an immediate life-threatening risk compared to the respiratory compromise indicated by bilateral basilar crackles. Educationally, understanding the significance of different assessment findings in older patients is vital for nurses to provide timely and appropriate care. This case underscores the importance of prioritizing assessments based on the urgency of the situation and acting quickly to address critical issues that may arise in the care of older adults with complex health needs.