Nursing Elites

1. A female client with a history of chronic obstructive pulmonary disease (COPD) is being treated at home and is currently receiving oxygen at 2 liters via nasal cannula. The spouse, who is the caregiver, reports that the client requires assistance when ambulating short distances, including going to the bathroom. Which suggestion should the health care nurse provide to the caregiver?

• A. disconnect oxygen when ambulating to the bathroom
• B. administer a breathing treatment prior to ambulation
• C. suggest obtaining a bedside commode for toileting
• D. ask for additional assistance to reduce the risk of falls

Correct answer: C

Rationale: For a client with COPD requiring assistance for short-distance ambulation, suggesting a bedside commode for toileting is the most appropriate intervention. This recommendation helps reduce the need for the client to walk long distances, thereby minimizing the risk of exertion and potential falls. Disconnecting oxygen during ambulation (Choice A) is not safe for a client with COPD, as oxygen therapy should be continuous. Administering a breathing treatment before ambulation (Choice B) may not directly address the client's need for assistance with toileting. Asking for additional assistance (Choice D) can be beneficial but providing a bedside commode specifically addresses the current issue of ambulating short distances for toileting.

2. The healthcare provider is assessing a client who has a new arteriovenous fistula in the left arm for hemodialysis. Which finding requires immediate intervention?

• A. A thrill is palpable on the fistula.
• B. The client's arm is warm and red.
• C. The fistula has a bruit on auscultation.
• D. There is no bruit on auscultation.

Correct answer: B

Rationale: The correct answer is B. Warmth and redness in the client's arm suggest infection or thrombosis of the arteriovenous fistula, which requires immediate intervention to prevent complications. A thrill (A) is a normal finding in a functional arteriovenous fistula, indicating good blood flow. A bruit (C) is also a normal finding on auscultation of a functioning arteriovenous fistula, indicating proper blood flow. The absence of a bruit (D) may indicate a non-functioning fistula, which would need further evaluation but does not require immediate intervention as warmth and redness do.

3. After coronary artery bypass graft surgery, a male client is admitted to the coronary care unit. Which nursing diagnosis is of the highest priority?

• A. Ineffective breathing pattern.
• B. Impaired gas exchange.
• C. Acute pain.
• D. Risk for infection.

Correct answer: B

Rationale: Impaired gas exchange is the highest priority nursing diagnosis because it directly impacts the client's oxygenation. Following coronary artery bypass graft surgery, ensuring adequate oxygen exchange is crucial for the client's recovery. Ineffective breathing pattern, although important, may not be as critical as impaired gas exchange in the immediate postoperative period. Acute pain, while significant, can be managed effectively with appropriate interventions and is not as emergent as addressing impaired gas exchange. Risk for infection is also a valid concern post-surgery, but ensuring optimal gas exchange takes precedence to prevent complications associated with inadequate oxygenation.

4. A community health nurse is addressing the issue of elder abuse in the community. Which intervention should be prioritized?

• A. providing education on the signs of elder abuse
• B. setting up a support group for elder abuse survivors
• C. partnering with local law enforcement to increase patrols
• D. creating a confidential hotline for reporting abuse

Correct answer: D

Rationale: The prioritized intervention for addressing elder abuse in the community should be the creation of a confidential hotline for reporting abuse. A confidential hotline offers a safe and accessible way for individuals to report elder abuse and seek help promptly. Providing education on the signs of elder abuse (Choice A) is important but may not directly address immediate reporting and intervention needs. Setting up a support group for elder abuse survivors (Choice B) is beneficial for emotional support but may not address the primary need for reporting abuse. Partnering with local law enforcement to increase patrols (Choice C) focuses on prevention rather than providing a direct reporting mechanism for victims.

5. The healthcare provider provides teaching to a group of evacuees in a mass casualty center after a natural flooding disaster. Which information should the healthcare provider include in the teaching plan? (select one that does not apply.)

• A. wash all fruits and vegetables thoroughly in running tap water
• B. identify all sexual contacts since the evacuation process
• C. take all doses of prophylactic prescriptions for diarrhea
• D. clean hands using soap, clean water, or waterless antibacterial solutions

Correct answer: B

Rationale: In the aftermath of a flooding disaster, educating evacuees on proper hygiene practices like washing fruits and vegetables, taking prophylactic prescriptions, and practicing hand hygiene is crucial to prevent the spread of diseases. Option B, identifying sexual contacts, is not relevant to preventing post-disaster health risks and should not be included in the teaching plan.

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