The nurse is teaching a patient with COPD about the use of a metered-dose inhaler. Which action by the patient indicates a need for further instruction?

Correct Answer: C

Rationale: The correct answer is C because exhaling quickly after inhaling the medication can lead to the medication being exhaled before it reaches the lungs. Holding the breath for 5 seconds after inhalation (A) allows the medication to be absorbed. Activating the inhaler during inhalation (B) ensures the medication is properly delivered. Waiting 1 minute between puffs (D) allows for optimal medication absorption.

Correct Answer: C

Rationale: The correct answer is C, Oxygen saturation of 87%. This finding indicates severe hypoxemia, which can be life-threatening in pulmonary embolism. Immediate action is needed to improve oxygenation and prevent further complications. A: Heart rate of 110 bpm and B: Respiratory rate of 30 bpm are concerning but not as immediately life-threatening as severe hypoxemia. D: Crackles heard in bilateral lung bases suggest pulmonary congestion but may not require immediate action compared to severe hypoxemia.

Correct Answer: B

Rationale: The correct answer is B: Oxygen saturation of 85% on room air. In chronic bronchitis, the airways are inflamed, leading to poor oxygen exchange. An oxygen saturation of 85% is dangerously low and indicates severe hypoxemia, requiring immediate intervention to prevent tissue damage and respiratory failure. A: Respiratory rate of 22 breaths per minute is within the normal range and not an immediate concern. C: Frequent productive cough with clear sputum is a common symptom of chronic bronchitis and does not necessitate immediate action. D: Barrel-shaped chest is a long-term consequence of chronic bronchitis due to chronic hyperinflation of the lungs and does not require immediate action.

Correct Answer: C

Rationale: The correct answer is C: Albuterol. During an acute asthma attack, a short-acting bronchodilator like albuterol is the first-line treatment to quickly open up the airways, relieve bronchospasm, and improve breathing. Albuterol acts rapidly to provide immediate relief of symptoms. Montelukast (A) is a leukotriene receptor antagonist used for long-term asthma control. Salmeterol (B) is a long-acting bronchodilator used for maintenance therapy, not for acute attacks. Ipratropium (D) is an anticholinergic bronchodilator that is used as an adjunctive therapy but not typically first-line for acute exacerbations.

Correct Answer: B

Rationale: The correct answer is B: Pulmonary embolism. This is suspected in a patient with dyspnea and pleuritic chest pain due to a blood clot blocking blood flow in the lungs. Pneumonia (A) presents with cough and fever. Asthma exacerbation (C) presents with wheezing and cough. Bronchitis (D) presents with productive cough and chest discomfort. Pulmonary embolism is the most critical condition to consider in a patient with sudden-onset dyspnea and pleuritic chest pain.