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. A 6-year-old child is alert but quiet when brought to the emergency center with periorbital ecchymosis and ecchymosis behind the ears. The nurse suspects potential child abuse and continues to assess the child for additional manifestations of a basilar skull fracture. What assessment finding would be consistent with the basilar skull fracture?

• A. Blurred vision.
• B. Shoulder pain.
• C. Abdominal pain.
• D. Rhinorrhea or otorrhea with halo sign.

Correct answer: D

Rationale: The correct answer is D: Rhinorrhea or otorrhea with halo sign. Raccoon eyes (periorbital ecchymosis) and Battle's sign (ecchymosis behind the ear) are signs of a basilar skull fracture, indicating the need to assess for possible meningeal tears that manifest as a halo sign with cerebrospinal fluid (CSF) leakage from the ears or nose. Choices A, B, and C are incorrect because blurred vision, shoulder pain, and abdominal pain are not typically associated with a basilar skull fracture.

3. During a home visit, the nurse finds that an elderly client has multiple expired medications. What should the nurse do first?

• A. instruct the client to dispose of the expired medications
• B. review the client's current medication regimen
• C. contact the client's healthcare provider
• D. educate the client on the dangers of taking expired medications

Correct answer: B

Rationale: The correct first action for the nurse to take when finding multiple expired medications in an elderly client's home is to review the client's current medication regimen. This step is crucial to identify any potential issues, ensure the client is taking the correct medications, and understand why the expired medications were not used. Instructing the client to dispose of the expired medications (Choice A) can come after understanding the current medication situation. Contacting the client's healthcare provider (Choice C) may be necessary but reviewing the medication regimen should be the initial step. Educating the client on the dangers of taking expired medications (Choice D) is important but should be done after addressing the immediate concern of reviewing the current medications.

4. The nurse is preparing to administer an oral medication to a client with dysphagia. Which action should the nurse take?

• A. Crush the medication and mix it with applesauce.
• B. Have the client drink a full glass of water with the medication.
• C. Administer the medication with a small amount of pudding.
• D. Place the medication at the back of the client's tongue.

Correct answer: C

Rationale: The correct action for the nurse to take when administering oral medication to a client with dysphagia is to administer the medication with a small amount of pudding. This method helps prevent aspiration in clients with dysphagia by ensuring easier swallowing. Crushing the medication and mixing it with applesauce (Choice A) might alter the medication's efficacy. Having the client drink a full glass of water with the medication (Choice B) may not be suitable for a client with dysphagia as it can increase the risk of aspiration. Placing the medication at the back of the client's tongue (Choice D) can also lead to aspiration and is not recommended.

5. The healthcare professional is conducting a community assessment to identify health needs. Which method is most effective for gathering comprehensive data?

• A. conducting focus groups with community members
• B. reviewing local health department reports
• C. surveying healthcare providers in the area
• D. analyzing hospital admission records

Correct answer: A

Rationale: Conducting focus groups with community members is the most effective method for gathering comprehensive data during a community assessment. This approach allows direct interaction with community members, fostering in-depth discussions that provide insights into the specific health needs and concerns of the community. Choice B, reviewing local health department reports, may offer valuable data but might not capture the nuanced perspectives and experiences of community members. Choice C, surveying healthcare providers, provides insights from a professional standpoint but may not fully represent the community's diverse health needs. Choice D, analyzing hospital admission records, offers information on healthcare utilization but may overlook important social determinants of health and community-specific issues that can only be addressed through direct engagement with community members.

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