Medical Surgical Assessment & Lung sounds #4


An obese client with a history of smoking and type 2 diabetes arrives to the clinic with respiratory symptoms of bronchitis. Which of the following is a priority to include in instructions?


  1. Lose 20 pounds.
    • Rationale:

      This answer is not correct because this is not the priority teaching for a client who smokes and has a diagnosis of chronic bronchitis. Weight loss is important for diabetic clients but the most immediate threat to the client is the irreversible damage to the bronchi caused by smoking.

  2. Avoid cigarette smoking.
    • Rationale:

      This answer is correct because smoking is a major risk factor for developing bronchitis that may occur after inflammation to the bronchial airway and is a component of developing COPD.

  3. Drink plenty of fluids.
    • Rationale:

      This answer is not correct because although drinking fluids is important to keep secretions thin, this is not the priority teaching point. The client is at risk for developing chronic bronchitis and will develop it, if the client continues to smoke.

  4. Decrease activity.
    • Rationale:

      This answer is not correct because teaching the client to decrease activity is not advisable. The client should be taught instead to monitor oxygenation status during activity and rest as needed.


The focus of this question is choosing the most appropriate education to provide to a client with symptoms of bronchitis. Cigarette smoking irritates the bronchi causing inflammation and decreases ciliary activity which worses symptoms of bronchitis.


Learning Outcomes

Bronchitis is characterized by a productive cough and results from repeated irritation of the large airways by smoke or prolonged, severe coughing. When the bronchi become irritated and inflamed, the goblet cells overproduce mucus which results in the productive cough that occurs in bronchitis. Cigarette smoking is the underlying risk factor that this client has for his symptoms of bronchitis. The nurse should instruct the client to avoid cigarette smoke to avoid worsening of present symptoms or the development of chronic bronchitis.

Test Taking Tip

Many times if the question is a client teaching question, cigarette smoking will definitely be the priority, if it is an answer option.

Video Rationale