during a follow up home visit the nurse observes that a client with chronic obstructive pulmonary disease copd is using accessory muscles to breathe a
Logo

Nursing Elites

HESI RN

HESI Community Health

1. During a follow-up home visit, the nurse observes that a client with chronic obstructive pulmonary disease (COPD) is using accessory muscles to breathe and has a pulse oximetry reading of 88%. What action should the nurse take first?

Correct answer: C

Rationale: In this situation, the nurse should first instruct the client to perform pursed-lip breathing. Pursed-lip breathing helps improve oxygenation and decrease the work of breathing in clients with COPD. Administering a bronchodilator or increasing the oxygen flow rate may be necessary interventions but addressing the breathing technique through pursed-lip breathing is the initial action to optimize oxygenation. Notifying the healthcare provider immediately is not the first action indicated in this scenario; the nurse should intervene promptly to assist the client in improving breathing before escalating the situation.

2. When planning a community health fair to promote mental health awareness, which activity should be included to best engage participants?

Correct answer: A

Rationale: The best activity to engage participants in a community health fair promoting mental health awareness is to offer free mental health screenings. This activity not only attracts participants but also provides them with immediate, valuable information about their mental health status. Free screenings can help raise awareness, encourage early detection of mental health issues, and prompt participants to seek further assistance if needed. Lectures, while informative, may not be as engaging or impactful as the personalized feedback individuals receive from screenings. Distributing resources is helpful, but active engagement through screenings is more effective in promoting awareness and encouraging action. Interactive workshops on stress management are beneficial but might not provide the same level of individualized insight into mental health as screenings do.

3. A school nurse is developing a health risk screening protocol for use at an elementary school. What information is most important for the nurse to include in this protocol?

Correct answer: B

Rationale: Weight and height measurements are crucial components of health screenings in children as they help assess growth patterns and identify potential health concerns such as obesity or growth disorders. Monitoring weight and height regularly can aid in early intervention and prevention of health issues. Annual flu vaccination status, total cholesterol level, and long bone deformity testing are not typically primary components of routine health screenings in elementary school children and may not directly contribute to identifying common health risks in this population.

4. A school nurse is planning a program to address bullying among students. Which strategy is most likely to be effective?

Correct answer: D

Rationale: Promoting bystander intervention is the most effective strategy as it empowers students to take action and prevent bullying incidents. By encouraging bystanders to intervene when they witness bullying, the behavior is less likely to continue. Zero-tolerance policies may have limited effectiveness as they often focus on punishment rather than prevention. Peer mediation and conflict resolution workshops are valuable but may not directly address the immediate need for bystander intervention in bullying situations.

5. The healthcare provider is assessing a client who has a nasogastric tube to low intermittent suction. Which finding indicates that the client may have developed hypokalemia?

Correct answer: A

Rationale: Muscle weakness and cramps are characteristic signs of hypokalemia, a condition marked by low levels of potassium in the blood. Potassium is essential for proper muscle function, and its deficiency can lead to muscle weakness and cramps. In the context of a client with a nasogastric tube to low intermittent suction, the loss of potassium through suctioning can contribute to the development of hypokalemia. Nausea and vomiting (choice B) are more commonly associated with gastrointestinal issues rather than hypokalemia. Constipation (choice C) is not a typical finding of hypokalemia; instead, it can be a sign of other gastrointestinal problems. Increased blood pressure (choice D) is not a direct manifestation of hypokalemia; in fact, low potassium levels are more commonly associated with decreased blood pressure.

Similar Questions

Who is likely to have the most influence on these women's perceptions about their children's healthcare needs?
A public health nurse is evaluating a program designed to reduce the incidence of sexually transmitted infections (STIs) among teenagers. Which outcome indicates that the program is successful?
A community health nurse is conducting a needs assessment in a rural area. Which data source is most likely to provide comprehensive information about the community's health status?
Because this year's demographics reflect that a large percentage of the population is less than 19 years of age, a community group proposes building a new well-child clinic. Which question indicates that the nurse understands the potential gaps in this data?
The healthcare provider is assessing a client who has returned from surgery. Which finding requires immediate intervention?

Access More Features

HESI RN Basic
$69.99/ 30 days

  • 5,000 Questions with answers
  • All HESI courses Coverage
  • 30 days access

HESI RN Premium
$149.99/ 90 days

  • 5,000 Questions with answers
  • All HESI courses Coverage
  • 30 days access

Other Courses