Nursing Elites

1. A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with pneumonia. Which finding requires immediate intervention?

• A. Oxygen saturation of 88%
• B. Respiratory rate of 24 breaths per minute
• C. Heart rate of 90 beats per minute
• D. Productive cough with green sputum

Correct answer: D

Rationale: In a client with COPD admitted with pneumonia, a productive cough with green sputum indicates a potential bacterial infection. Green sputum is commonly associated with bacterial pneumonia, which requires immediate intervention with appropriate antibiotics. Monitoring oxygen saturation, respiratory rate, and heart rate are essential in COPD patients, but the presence of green sputum suggests an urgent need for targeted treatment to address the underlying infection. Oxygen saturation of 88% is concerning but may not directly indicate the need for immediate intervention in the absence of other critical symptoms. Respiratory rate of 24 breaths per minute and a heart rate of 90 beats per minute are within normal limits and may not be indicative of an acute issue requiring immediate intervention in this context.

2. The nurse is caring for a client with diabetic ketoacidosis (DKA). Which laboratory result requires immediate intervention?

• A. Blood glucose of 250 mg/dL.
• B. Serum potassium of 3.5 mEq/L.
• C. Serum sodium of 135 mEq/L.
• D. Arterial blood pH of 7.30.

Correct answer: D

Rationale: An arterial blood pH of 7.30 indicates the client is in acidosis, which is a life-threatening condition in DKA. Immediate intervention is required to correct the acidosis and prevent further complications such as organ failure or coma. Blood glucose of 250 mg/dL is elevated but not an immediate threat to life in comparison to acidosis. Serum potassium of 3.5 mEq/L and serum sodium of 135 mEq/L are within normal ranges and do not warrant immediate intervention in the context of DKA.

3. During a 2-week postoperative follow-up home visit, a female client who had gastric bypass surgery exhibits abdominal tenderness, shoulder pain, and describes feelings of malaise. Her vital signs are: T 101.8, BP 100/50, HR 104, and RR 18. Which action should the RN take?

• A. have the client transported via ambulance to the hospital
• B. recheck the client's vital signs in 30 minutes
• C. instruct the client to drive to the hospital for admission
• D. assess the client's current symptoms

Correct answer: A

Rationale: The client is presenting with signs of a potential postoperative complication, such as fever, low blood pressure, and tachycardia, which could indicate sepsis or another serious issue. These symptoms require immediate hospital evaluation and management. Option B of rechecking vital signs in 30 minutes could delay crucial intervention in a potentially life-threatening situation. Option C is unsafe as the client should not drive herself due to her condition. Option D is vague and does not address the urgency of the situation.

4. The healthcare provider is assessing a client who is receiving total parenteral nutrition (TPN). Which finding requires immediate intervention?

• A. Blood glucose level of 150 mg/dL.
• B. Weight gain of 2 pounds in 24 hours.
• C. Decreased urine output.
• D. Temperature of 100.3°F (37.9°C).

Correct answer: C

Rationale: Decreased urine output in a client receiving total parenteral nutrition (TPN) requires immediate intervention because it can indicate potential complications such as fluid overload or kidney dysfunction. Monitoring urine output is crucial in assessing renal function and fluid balance in patients on TPN. A blood glucose level of 150 mg/dL is within a normal range and may not require immediate intervention. Weight gain of 2 pounds in 24 hours could be a concern but may not be as urgent as addressing decreased urine output. A temperature of 100.3°F (37.9°C) is slightly elevated but may not be directly related to TPN administration unless there are other symptoms of infection present.

5. A public health nurse is assessing a community's readiness for a new smoking cessation program. Which factor is most important to evaluate?

• A. the community's smoking rates
• B. the availability of smoking cessation resources
• C. the community's attitude towards smoking
• D. the local healthcare providers' support for the program

Correct answer: C

Rationale: The most critical factor to evaluate when assessing a community's readiness for a smoking cessation program is the community's attitude towards smoking. Understanding the community's perceptions, beliefs, and behaviors related to smoking is crucial as it helps determine the level of receptiveness and potential success of the program. Assessing smoking rates (Choice A) could provide valuable epidemiological data but may not reflect the community's readiness for change. While the availability of smoking cessation resources (Choice B) is important, without considering the community's attitude, the program's effectiveness may be limited. Local healthcare providers' support (Choice D) is valuable but secondary to the community's attitude, which directly influences the program's acceptance and impact.

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