Nursing Elites

1. A 15-year-old client with a lengthy confining illness is at risk for altered growth and development of which task?

• A. Loss of control
• B. Insecurity
• C. Dependence
• D. Lack of trust

Correct answer: C

Rationale: A 15-year-old client with a lengthy confining illness is at risk for altered growth and development of the task of dependence. Prolonged illness and confinement can lead to the development of dependence as the individual may become reliant on others for their care and needs. Choices A, B, and D are incorrect in this context. Loss of control, insecurity, and lack of trust are important factors to consider but are not directly related to the altered growth and development task of dependence due to illness and confinement.

2. During the beginning shift assessment of a client with asthma who is receiving oxygen via nasal cannula at 2 liters per minute, the nurse would be most concerned about which unreported finding?

• A. Pulse oximetry reading of 89%
• B. Crackles at the base of the lungs on auscultation
• C. Rapid shallow respirations with intermittent wheezes
• D. Excessive thirst with a dry cracked tongue

Correct answer: C

Rationale: Rapid, shallow respirations with intermittent wheezes are concerning as they indicate a potential worsening of the client's asthma. This finding suggests airway narrowing, which can lead to respiratory failure. Immediate intervention is required to address this respiratory distress. A pulse oximetry reading of 89% is low and indicates hypoxemia, but the respiratory pattern described in option C takes priority as it directly reflects the client's respiratory status. Crackles at the base of the lungs suggest fluid accumulation, which is important but not as immediately critical as the respiratory distress in asthma. Excessive thirst and a dry cracked tongue may indicate dehydration, which is relevant but not as urgent as the respiratory compromise presented in option C.

3. While caring for the client during the first hour after delivery, the nurse determines that the uterus is boggy and there is vaginal bleeding. What should be the nurse's first action?

• A. Check vital signs
• B. Massage the fundus
• C. Offer a bedpan
• D. Check for perineal lacerations

Correct answer: B

Rationale: The correct action for the nurse to take when encountering a boggy uterus and vaginal bleeding after delivery is to massage the fundus. Massaging the fundus helps the uterus contract, which can reduce vaginal bleeding. Checking vital signs may be important but addressing the uterine atony and bleeding takes precedence. Offering a bedpan or checking for perineal lacerations are not the immediate actions needed to manage postpartum hemorrhage.

4. The delivery of basic health services was decentralized to the local government units. The legal basis for this is embodied in:

• A. RA 7035
• B. EO 119
• C. RA 7160
• D. PD 999

Correct answer: C

Rationale: The correct answer is C, RA 7160. This law, also known as the Local Government Code, decentralizes health services to local government units. RA 7035 is not the legal basis for decentralizing basic health services. EO 119 and PD 999 are also not the correct legal bases for the decentralization of health services.

5. The home health care agency can expect to obtain Medicare reimbursement for which home visit performed by a registered nurse (RN) or a practical nurse (PN)?

• A. Assessment of the speech pattern of a mobile adult who had a mild stroke last year.
• B. Safety teaching for an older male client whose wife complains that he uses an unsafe ladder while painting.
• C. Wound care for a client who had a postoperative infection following abdominal surgery two weeks ago.
• D. Evaluation of crutch use by a 65-year-old male client who broke his tibia while snow skiing.

Correct answer: C

Rationale: The correct answer is C because wound care for a postoperative infection is a skilled service that qualifies for Medicare reimbursement. Choices A, B, and D involve assessments, teaching, and evaluation, which may not meet the criteria for Medicare reimbursement as they do not directly involve a skilled nursing service related to a postoperative condition.

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