Nursing Elites

1. The healthcare provider is assessing a client with chronic obstructive pulmonary disease (COPD). Which finding requires immediate intervention?

• A. Oxygen saturation of 88%.
• B. Use of accessory muscles for breathing.
• C. Respiratory rate of 26 breaths per minute.
• D. Barrel-shaped chest.

Correct answer: C

Rationale: A respiratory rate of 26 breaths per minute is an abnormal finding and indicates that the client is experiencing respiratory distress, requiring immediate intervention. This rapid respiratory rate can signify inadequate oxygenation and ventilation. Oxygen saturation of 88% is low but not as immediately concerning as a high respiratory rate, which indicates the body is compensating for respiratory distress. The use of accessory muscles for breathing and a barrel-shaped chest are typical findings in clients with COPD but do not indicate an immediate need for intervention as they are more chronic in nature and may be seen in stable COPD patients.

2. To prepare a presentation on the greatest health concern facing the city, how should the health nurse begin collecting data?

• A. Review morbidity data for the city's population compiled by the Bureau of Vital Statistics
• B. Conduct a random telephone survey to determine the public's perception about health problems
• C. Survey major hospitals in the area to determine the most common reasons for admissions
• D. Call American Medical Association members to determine the most frequently treated diagnoses

Correct answer: A

Rationale: The correct answer is to review morbidity data for the city's population compiled by the Bureau of Vital Statistics. Morbidity data provides detailed and accurate information on the health issues prevalent in the city's population. This data is essential as it reflects actual health conditions rather than perceptions or specific hospital data. Conducting a telephone survey (choice B) may provide subjective opinions rather than objective data. Surveying hospitals (choice C) may only capture data on hospitalized cases and may not represent the entire population. Contacting American Medical Association members (choice D) may provide insights into medical treatments but may not reflect the overall health concerns of the city's population.

3. A home health nurse is reviewing the laboratory results for several clients with heart failure. Which client finding would the nurse report to the health care provider immediately?

• A. Total cholesterol 190
• B. Glycosylated hemoglobin of 7%
• C. B-type natriuretic peptide 550 pg/ml (more than 100 is concerning)
• D. Potassium 3.7

Correct answer: C

Rationale: An elevated B-type natriuretic peptide level indicates worsening heart failure, requiring immediate attention. This biomarker reflects the severity of heart failure and helps guide treatment decisions. Total cholesterol and glycosylated hemoglobin are important for assessing cardiovascular risk and diabetes management but are not indicative of acute heart failure exacerbation. A potassium level of 3.7 falls within the normal range and does not suggest an immediate concern in the context of heart failure.

4. When caring for a client with a chest tube, which intervention is most important to include in the plan of care?

• A. Maintain continuous suction on the chest tube.
• B. Clamp the chest tube during client movement.
• C. Ensure that the chest tube is clamped for at least 8 hours each day.
• D. Keep the collection chamber below the level of the chest.

Correct answer: D

Rationale: Keeping the collection chamber below the level of the chest is crucial in caring for a client with a chest tube. This positioning helps ensure proper drainage of fluids and prevents complications such as backflow of drainage into the chest cavity. Option A is incorrect as continuous suction can lead to excessive drainage and tissue damage. Option B is incorrect as clamping the chest tube during client movement can cause a buildup of pressure and compromise proper drainage. Option C is incorrect because clamping the chest tube for extended periods can impede the drainage process, leading to potential complications.

5. 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.

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