Nursing Elites

1. 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.

2. During a home visit for a family with a new baby, what should the nurse assess first?

• A. feeding patterns
• B. sleeping arrangements
• C. support system
• D. immunization status

Correct answer: A

Rationale: Assessing feeding patterns is the priority during a home visit for a family with a new baby because it is crucial for the health and growth of the newborn. By evaluating the feeding patterns, the nurse can ensure that the baby is receiving adequate nutrition and address any feeding issues promptly. While sleeping arrangements, support system, and immunization status are important aspects to assess during a home visit, they are not as critical as ensuring the newborn's nutritional needs are being met.

3. 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.

4. What title should be given to this occupational health nurse job description? A registered nurse who functions in a comprehensive executive role to set goals, formulate policy, and direct and evaluate the health service.

• A. manager
• B. researcher
• C. health educator
• D. health promotion specialist

Correct answer: A

Rationale: The correct answer is 'manager.' In the job description provided, the role involves setting goals, formulating policy, and directing and evaluating health services, which aligns with the responsibilities of a manager. A 'researcher' primarily focuses on conducting research, a 'health educator' specializes in educating individuals about health-related topics, and a 'health promotion specialist' concentrates on promoting health and wellness initiatives. Therefore, 'manager' is the most suitable title for the described role.

5. An example of individual influences on health status would be:

• A. Cigarette smoking
• B. A parent with adult-onset diabetes
• C. Exposure to toxic substances in the workplace
• D. All of the above

Correct answer: D

Rationale: The correct answer is 'D' because all the listed factors - cigarette smoking, a parent with adult-onset diabetes, and exposure to toxic substances in the workplace - can individually influence a person's health status. Cigarette smoking directly impacts health by increasing the risk of various diseases. Having a parent with adult-onset diabetes can also influence one's health due to genetic predisposition and lifestyle factors. Exposure to toxic substances in the workplace can lead to health issues. Choices A, B, and C are not mutually exclusive but rather represent different aspects of individual influences on health status, making 'D' the most comprehensive and accurate answer.

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