Nursing Elites

1. The nurse is assessing a client with chronic obstructive pulmonary disease (COPD). Which of the following findings should the nurse expect?

• A. Decreased anteroposterior diameter
• B. Hyperresonance on percussion
• C. Increased breath sounds
• D. Prolonged expiratory phase

Correct answer: D

Rationale: The correct answer is D: Prolonged expiratory phase. In COPD, there is airflow obstruction leading to difficulty in exhaling air. This results in a prolonged expiratory phase. Choices A, B, and C are incorrect. Decreased anteroposterior diameter is associated with conditions like barrel chest in emphysema, not COPD. Hyperresonance on percussion is typical in conditions like emphysema, not necessarily in COPD. Increased breath sounds are not a typical finding in COPD; instead, diminished breath sounds may be present due to air trapping.

2. Under which level of primary health care workers does a rural sanitary inspector fall?

• A. Village health workers
• B. Intermediate level health workers
• C. Barangay health workers
• D. All of the above

Correct answer: B

Rationale: Rural sanitary inspectors are classified as intermediate level health workers. They are not categorized under village health workers or barangay health workers. Therefore, the correct answer is B.

3. A hospitalized child suddenly has a seizure while his family is visiting. The nurse notes whole body rigidity followed by general jerking movements. The child vomits immediately after the seizure. A priority nursing diagnosis for the child is

• A. High risk for infection related to vomiting
• B. Altered family processes related to chronic illness
• C. Fluid volume deficit related to vomiting
• D. Risk for aspiration related to loss of consciousness

Correct answer: D

Rationale: Risk for aspiration is a priority concern following a seizure, especially when the child vomits, as there is a danger of aspirating the vomit into the lungs, leading to respiratory complications. The other options are not the priority in this situation. While infection risk and fluid volume deficit are important, ensuring the child's airway is clear and there is no risk of aspiration takes precedence. Altered family processes may be a concern but addressing the immediate physiological risk is the priority.

4. The nurse is caring for a client admitted to the hospital with right lower lobe (RLL) pneumonia. On assessment, the nurse notes crackles over the RLL. The client has significant pleuritic pain and is unable to take in a deep breath in order to cough effectively.

• A. Impaired gas exchange related to acute infection and sputum production
• B. Ineffective airway clearance related to sputum production and ineffective cough
• C. Ineffective breathing pattern related to acute infection
• D. Anxiety related to hospitalization and role conflict

Correct answer: B

Rationale: The client's inability to effectively clear the airway due to pain and sputum production hinders the cough mechanism, making 'Ineffective airway clearance' the most appropriate nursing diagnosis. Although impaired gas exchange may occur due to the pneumonia, the immediate issue is the inability to clear the airway. 'Ineffective breathing pattern' does not address the specific issue of airway clearance. 'Anxiety' is not the priority when the focus should be on the physical complications of pneumonia.

5. The home health nursing director is conducting an educational program for registered nurses and practical nurses about Medicare reimbursement. To obtain payment for Medicare services, what must be included in the client's record?

• A. A prescription from the healthcare provider for each visit made.
• B. Documentation of a skilled care service provided during the visit.
• C. A copy of the client's health history and social security card.
• D. A record of the preventative healthcare services provided during the visit.

Correct answer: B

Rationale: The correct answer is B: Documentation of skilled care services is required for Medicare reimbursement. Medicare reimbursement is based on the provision of skilled care services, not on prescriptions or preventative healthcare services. Including a copy of the client's health history and social security card is not a requirement for Medicare reimbursement.

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