A client with severe chronic obstructive pulmonary disease becomes dyspneic and fatigued halfway through meals and has unintentionally lost weight. Which nursing plan best supports nutrition?
1Serve three large calorie-rich meals and encourage the client to finish each one
2Offer most fluids before and during meals to increase the total daily intake
3Schedule meals immediately after strenuous activity to build endurance
4Offer small nutrient-dense meals after rest and allow time to eat slowly✓ Correct answer
Explanation
Small nutrient-dense meals reduce the work of eating while increasing calorie intake. Rest before meals and slow pacing conserve energy. Large meals, heavy fluid intake with food, and meals after exertion can worsen fullness, fatigue, or dyspnea.
Quick answer Use small nutrient-dense meals after rest, with enough time for slow eating.
Why this is correct Severe lung disease increases the energy cost of breathing, while dyspnea can make eating exhausting. Smaller calorie-dense meals reduce gastric fullness and work per sitting; rest and unhurried pacing preserve limited energy for chewing and swallowing.
Easy analogy or mental picture Nutrition is planned like several short trips instead of one overloaded trip: each meal asks less of limited respiratory reserve. The comparison does not set a universal meal size or replace individualized dietitian assessment.
NCLEX decision rule When dyspnea and fatigue limit intake, reduce the effort of eating while preserving calories and protein. Choose small nutrient-dense meals, rest beforehand, and avoid strategies that increase fullness or post-exertional fatigue.
Why the other choices are wrong Large meals increase abdominal fullness and effort. Drinking most fluids with meals can cause early satiety, and scheduling food immediately after exertion uses the period of greatest fatigue.
References
[1]
NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing
[2]
COPD: Living WithNational Heart, Lung, and Blood Institute
Clinical Practice GuideFor Indwelling urinary catheter care, compare the complete cue pattern with the client's current stability, ordered data, and expected nursing scope.
CautionDo not choose an action from one isolated cue when the full scenario changes priority or safety.
Indwelling Urinary Catheter — A tube left in the bladder to drain urine continuously.
Closed Drainage System — A catheter system kept sealed to reduce contamination.
Backflow — Reverse movement of urine that can carry organisms toward the bladder.