1. A community nurse is conducting a home visit for a 65-year-old man with

chronic obstructive pulmonary disease (COPD). The nurse observes that the patient

has difficulty breathing, cyanosis, and a productive cough with yellowish sputum.

The nurse also notes that the patient smokes half a pack of cigarettes per day and

lives alone in a poorly ventilated apartment. What is the most appropriate nursing

diagnosis for this patient?

a) Ineffective airway clearance related to increased mucus production and smoking

b) Impaired gas exchange related to ventilation-perfusion imbalance and hypoxia

c) Activity intolerance related to decreased oxygen delivery and fatigue

d) Risk for infection related to impaired ciliary function and chronic inflammation

*Answer: b) Impaired gas exchange related to ventilation-perfusion imbalance and

hypoxia

Rationale: Impaired gas exchange is the most appropriate nursing diagnosis for this

patient because it reflects the underlying pathophysiology of COPD, which is a

chronic condition that causes airflow obstruction, alveolar damage, and

hypoxemia. Ineffective airway clearance, activity intolerance, and risk for infection

are also relevant nursing diagnoses for this patient, but they are not as specific or as

urgent as impaired gas exchange.

2. A community nurse is planning a health promotion program for a group of lowincome pregnant women who live in a rural area. The nurse identifies that one of

the main health problems affecting this population is iron-deficiency anemia. What

is the best strategy for the nurse to implement to prevent and treat iron-deficiency

anemia in this group?

a) Provide iron supplements and educate the women on the importance of taking

them regularly