Nursing Elites

1. The RN is making a home visit to a female client with end-stage heart disease. She has a living will and states she will never go back to the hospital. During the visit, the RN notes that the client is pale and SOB while speaking. The RN discovers 3+ edema in both ankles and bilateral pulmonary crackles. Which intervention should the RN implement first?

• A. Order a chest X-ray
• B. Obtain a peripheral O2 saturation reading
• C. Obtain an order for complete blood count
• D. Tell the patient to stay in bed

Correct answer: B

Rationale: Obtaining a peripheral O2 saturation reading is the priority intervention in this scenario. It helps assess the client's oxygenation status quickly, which is crucial in a client with signs of respiratory distress, such as shortness of breath and bilateral pulmonary crackles. Ordering a chest X-ray (Choice A) may be necessary later but does not address the immediate need for oxygen assessment. Obtaining an order for a complete blood count (Choice C) is not the priority in this situation as it does not directly address the client's respiratory distress. Instructing the patient to stay in bed (Choice D) does not address the underlying issue of potential hypoxia and respiratory compromise.

2. The Healthy People project is designed to:

• A. track health care trends to anticipate insurance liabilities, especially for poor and urban populations
• B. demonstrate that social factors have a significant impact on individual and community health
• C. follow health indicators such as activity, substance use, mental health, and environmental issues
• D. demonstrate that access to health care in the United States is adequate for all populations

Correct answer: C

Rationale: The Healthy People project is designed to follow health indicators such as activity, substance use, mental health, and environmental issues to improve public health outcomes. Choice A is incorrect because the project focuses on public health indicators rather than insurance liabilities. Choice B is incorrect as the project actually acknowledges the significant impact of social factors on health. Choice D is incorrect because one of the main goals of the Healthy People project is to identify and address disparities in access to healthcare, not to demonstrate that access is adequate for all populations.

3. What does the term 'health disparity' refer to?

• A. Equal access to healthcare for all individuals
• B. Differences in health outcomes between different population groups
• C. High-quality healthcare for everyone
• D. Providing the same treatments to everyone

Correct answer: B

Rationale: The correct answer is B. 'Health disparity' refers to differences in health outcomes between different population groups. This term highlights variations in health status or in the distribution of health determinants between different population groups. Choice A is incorrect as health disparity is about health outcomes, not just access to healthcare. Choice C is too broad and not specific to the concept of health disparity. Choice D is incorrect as health disparity recognizes that different populations may need tailored or different treatments based on their specific health needs.

4. With an alert of an internal disaster and the need for beds, the charge nurse is asked to list clients who are potential discharges within the next hour. Which client should the charge nurse select?

• A. An elderly client who has had type 2 diabetes for over 20 years, admitted with diabetic ketoacidosis 24 hours ago
• B. An adolescent admitted the prior night with Tylenol intoxication
• C. A middle-aged client with an internal automatic defibrillator and complaints of 'passing out at unknown times' admitted yesterday
• D. A school-age child diagnosed with suspected bacterial meningitis and was admitted at the change of shifts

Correct answer: A

Rationale: The correct answer is A because a client with diabetic ketoacidosis (DKA) that is being well-managed and has shown improvement within 24 hours is more stable and can be considered for discharge sooner than those with more acute or unstable conditions. Choice B is incorrect as Tylenol intoxication may require further monitoring and intervention. Choice C is incorrect as a client with an automatic defibrillator and episodes of passing out needs careful evaluation and monitoring. Choice D is incorrect as suspected bacterial meningitis is a serious condition that typically requires a longer hospital stay for treatment and observation.

5. A community health nurse is conducting a home visit to assess a family's health needs. What is the first step in this process?

• A. Develop a care plan
• B. Conduct a physical examination
• C. Establish rapport with the family
• D. Provide health education

Correct answer: C

Rationale: Establishing rapport with the family is crucial in the initial stages of a home visit. It helps build trust, open communication channels, and allows the nurse to gain insight into the family's health needs and concerns. Developing a care plan (Choice A) comes after the assessment phase, where information is gathered. Conducting a physical examination (Choice B) is a part of the assessment but typically follows establishing rapport. Providing health education (Choice D) is important but usually occurs after the assessment and care planning stages.

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