Question

The nurse notes that the client diagnosed with emphysema becomes restless and confused. Which action, if taken by the nurse, is BEST?

  • (1) Encourage the client to perform pursed-lip breathing.
  • (2) Check the client’s temperature.
  • (3) Assess the client’s potassium level.
  • (4) Increase the client’s oxygen flow rate to 5 L/min.

Answer

1. Encourage the client to perform pursed-lip breathing.

CORRECT- prevents collapse of lung unit, and helps client control rate and depth of breathing

2. Check the client’s temperature.

Incorrect- confusion is probably due to decreased oxygenation

3. Assess the client’s potassium level.

Incorrect- confusion is probably due to decreased oxygenation, not electrolyte imbalance

4. Increase the client’s oxygen flow rate to 5 L/min.

Incorrect- should receive low-flow oxygen to prevent CO2 narcosis

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