Nursing Elites

1. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen therapy. Which finding indicates that the therapy is effective?

• A. The client is able to expectorate secretions easily.
• B. The client's oxygen saturation is 92%.
• C. The client's respiratory rate is 20 breaths per minute.
• D. The client's arterial blood gases show a pH of 7.35.

Correct answer: C

Rationale: In a client with COPD receiving oxygen therapy, an effective response is indicated by a respiratory rate of 20 breaths per minute. This suggests that the client is effectively oxygenating while maintaining an appropriate respiratory rate. Choices A, B, and D are incorrect because expectorating secretions easily, having an oxygen saturation of 92%, and arterial blood gases showing a pH of 7.35 are not specific indicators of the effectiveness of oxygen therapy in COPD. Oxygen saturation of 92% may still be suboptimal in COPD, and arterial blood gases showing a pH of 7.35 may not necessarily reflect the overall effectiveness of oxygen therapy.

2. The nurse is developing a community health program to address the high rates of hypertension in a neighborhood. Which intervention should the nurse prioritize?

• A. conducting free blood pressure screenings
• B. distributing educational materials on hypertension
• C. holding workshops on stress management
• D. partnering with local gyms to offer discounted memberships

Correct answer: A

Rationale: Conducting free blood pressure screenings should be prioritized as it helps identify individuals with hypertension who may not be aware of their condition. Early detection allows for timely medical intervention and management. While distributing educational materials, holding stress management workshops, and partnering with local gyms are valuable interventions, they may not directly address the immediate need for identifying undiagnosed cases of hypertension in the community.

3. Prior to implementing a community health program targeting teenage smoking, which information is most important for the nurse to obtain?

• A. greater access to any healthcare provider
• B. allowance for early discharge
• C. Prevalence and patterns of smoking among teenagers
• D. approval by the network healthcare provider

Correct answer: C

Rationale: The most important information for the nurse to obtain before implementing a community health program targeting teenage smoking is the prevalence and patterns of smoking among teenagers. Understanding this data is crucial to tailor the program to the specific needs and behaviors of the target group, ensuring it addresses the root causes effectively. Choices A, B, and D are unrelated to the specific needs of the target group and do not provide essential information for designing an effective smoking cessation program for teenagers.

4. The nurse must delegate some aspects of a homebound client's care to a home health aide. Which intervention should the nurse delegate to the home health aide?

• A. evaluating a pressure sore
• B. applying a prosthetic device
• C. performing a sterile dressing change
• D. assessing the client's need for an elevated toilet seat

Correct answer: B

Rationale: The correct answer is B: applying a prosthetic device. Home health aides are trained and authorized to assist with the application and management of prosthetic devices for clients. Evaluating a pressure sore (choice A) requires clinical assessment and judgment typically performed by a licensed healthcare provider such as a nurse. Performing a sterile dressing change (choice C) involves aseptic technique and wound care skills that are usually performed by licensed healthcare professionals. Assessing the client's need for an elevated toilet seat (choice D) involves a level of assessment and decision-making that is beyond the scope of practice for a home health aide.

5. A client who is receiving intravenous heparin therapy has an activated partial thromboplastin time (aPTT) of 90 seconds. Which action should the nurse take?

• A. Continue the heparin infusion as prescribed.
• B. Decrease the heparin infusion rate.
• C. Increase the heparin infusion rate.
• D. Stop the heparin infusion and notify the healthcare provider.

Correct answer: D

Rationale: An aPTT of 90 seconds is significantly elevated, indicating a high risk of bleeding due to excessive anticoagulation. In this case, the heparin infusion should be stopped immediately to prevent further anticoagulation and an increased bleeding risk. Notifying the healthcare provider is essential to discuss alternative anticoagulation strategies or interventions. Continuing heparin therapy without action could lead to severe bleeding complications. Decreasing or increasing the heparin infusion rate would exacerbate the risk of bleeding, making options A, B, and C incorrect.

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