While performing an assessment, the nurse hears crackles in the patient's lung fields. The nurse also learns that the patient is sleeping on three pillows. What do these symptoms most likely indicate?

Correct Answer: A

Rationale: The crackles in the lung fields suggest fluid accumulation in the lungs, which is a common sign of left-sided heart failure. When the left side of the heart fails to pump effectively, blood backs up into the lungs, causing fluid leakage and crackles. The patient sleeping on three pillows is likely trying to alleviate difficulty breathing due to the lung congestion. Right-sided heart failure would typically present with symptoms such as peripheral edema and jugular venous distension, not crackles in the lungs. Atrial fibrillation is an arrhythmia that may lead to heart failure but does not directly cause crackles in the lung fields. Myocardial ischemia is related to inadequate blood flow to the heart muscle and does not directly cause crackles in the lungs.

Correct Answer: A

Rationale: Correct Answer: A Rationale: Exhaling fully before using the MDI helps create space in the lungs for the medication to reach deeper into the airways upon inhalation. This maximizes the effectiveness of the medication. Holding the breath for a few seconds after inhalation also allows the medication to be absorbed properly. Shaking the inhaler after use is not recommended as it may cause the medication to clump. Using the inhaler while lying flat can lead to improper inhalation technique and reduced effectiveness.

Correct Answer: C

Rationale: The correct answer is C: Barrel-shaped chest. In emphysema, the chronic destruction of alveoli leads to loss of lung elasticity, causing the chest to become hyperinflated and take on a barrel shape. This is due to air trapping in the lungs. A: Frequent productive cough is commonly seen in conditions like chronic bronchitis, not specific to emphysema. B: Cyanosis of lips and fingertips indicates poor oxygenation, which is more commonly associated with conditions like pneumonia or acute respiratory distress. D: Peripheral edema is a sign of fluid retention and heart failure, not typically seen in emphysema.

Correct Answer: A

Rationale: The correct answer is A: Short-acting beta2-agonist. During an acute asthma exacerbation, bronchodilation is the priority to relieve airway constriction and improve breathing. Short-acting beta2-agonists like albuterol act quickly to relax bronchial smooth muscles, providing immediate relief. This medication is the first-line treatment for acute exacerbations as it addresses the underlying bronchoconstriction. Inhaled corticosteroids (B) are used for long-term management and prevention of asthma symptoms, not for immediate relief. Leukotriene receptor antagonists (C) are typically used as adjunct therapy and not for acute exacerbations. Long-acting beta2-agonists (D) are used for maintenance therapy and should not be used as the initial treatment during an acute exacerbation.

Correct Answer: C

Rationale: The correct answer is C: Rest between activities to conserve energy. This intervention is appropriate for a client with COPD experiencing fatigue as it helps prevent overexertion and conserves energy. Resting between activities allows the client to pace themselves, reducing the risk of worsening symptoms. Performing all activities in the morning (choice A) may not address the fatigue throughout the day. Using oxygen only during strenuous activities (choice B) does not address the underlying issue of energy conservation. Increasing activity level to build endurance (choice D) may lead to further fatigue and exacerbate symptoms. Overall, choice C is the most suitable intervention for managing fatigue in a client with COPD.