Nursing Elites

1. Several employees who have a 10-year or longer smoking history ask for assistance with smoking cessation. A nurse develops a 2-month program that includes weekly group sessions on lifestyle changes and use of over-the-counter nicotine substitute products. Which measurement provides the best indication of the program's effectiveness?

• A. survey employees to determine how many are smoking 2 months after the end of the program
• B. test the employees' knowledge of OTC nicotine substitute products at the end of the program
• C. ask employees to inform the group if they stop smoking and if they start smoking again
• D. design a questionnaire that identifies lifestyle changes contributing to smoking cessation

Correct answer: A

Rationale: Surveying employees to determine how many are smoking 2 months after the end of the program provides a direct assessment of the program's effectiveness. This measurement evaluates the actual behavior change related to smoking cessation. Choice B, testing knowledge of OTC nicotine substitute products, does not directly measure smoking cessation outcomes. Choice C relies on self-reporting, which may not be accurate or reliable. Choice D focuses on identifying lifestyle changes but does not directly assess the program's impact on smoking cessation.

2. A public health nurse is implementing a program to improve vaccination rates among children in the community. Which intervention is most likely to be effective?

• A. Offering vaccinations at convenient locations and times
• B. Distributing educational materials about vaccines
• C. Providing incentives for getting vaccinated
• D. Hosting informational sessions for parents

Correct answer: A

Rationale: Offering vaccinations at convenient locations and times is the most effective intervention as it reduces barriers to access and makes it easier for parents to get their children vaccinated. This strategy directly addresses the issue of convenience and accessibility, which are common reasons for low vaccination rates. Distributing educational materials about vaccines (Choice B) can be helpful but may not directly address access issues. Providing incentives for getting vaccinated (Choice C) may be controversial and not sustainable in the long term. Hosting informational sessions for parents (Choice D) can be beneficial for education but may not directly improve vaccination rates as much as increasing access.

3. A client with a history of coronary artery disease is admitted with chest pain. Which finding requires immediate intervention?

• A. Heart rate of 90 beats per minute.
• B. Blood pressure of 130/80 mm Hg.
• C. Respiratory rate of 20 breaths per minute.
• D. Chest pain radiating to the left arm.

Correct answer: D

Rationale: The correct answer is D. Chest pain radiating to the left arm can be a sign of myocardial infarction (heart attack) and requires immediate intervention. This symptom is known as a classic presentation of a heart attack and warrants urgent medical attention to prevent further cardiac damage. Choices A, B, and C are not directly indicative of an acute cardiac event and may not require immediate intervention in this scenario. While heart rate, blood pressure, and respiratory rate are important vital signs to monitor, they do not specifically indicate the urgency associated with chest pain radiating to the left arm in a patient with a history of coronary artery disease.

4. The healthcare provider is assessing the laboratory results for a client who is admitted with renal failure and osteodystrophy. Which findings are consistent with this client's clinical picture?

• A. Serum potassium of 4.0 mEq/L and total calcium of 9 mg/dL.
• B. White blood cell count of 15,000/mm3.
• C. Serum potassium of 5.5 mEq/L and total calcium of 6 mg/dL.
• D. Hemoglobin of 12 g/dL and phosphorus of 2 mg/dL.

Correct answer: C

Rationale: In renal failure and osteodystrophy, there is an alteration in serum electrolyte balance. The correct answer is serum potassium of 5.5 mEq/L and total calcium of 6 mg/dL. Renal failure is associated with hyperkalemia (elevated serum potassium) and hypocalcemia (low total calcium levels). Hyperphosphatemia is also commonly seen in renal failure. Choice A is incorrect as it describes normal levels of serum potassium and total calcium. Choice B is unrelated to the client's condition. Choice D is incorrect as it does not reflect the typical electrolyte imbalances seen in renal failure and osteodystrophy.

5. 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.

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