Nursing Elites

1. The nurse is providing discharge teaching to a client with a new colostomy. Which statement by the client indicates a need for further teaching?

• A. I will avoid foods that cause gas.
• B. I will change my colostomy bag every week.
• C. I will use a skin barrier to protect the skin around the stoma.
• D. I will empty my colostomy bag when it is one-third full.

Correct answer: B

Rationale: The correct answer is B. Changing the colostomy bag every week is not sufficient; it should be changed more frequently to prevent leakage and skin irritation. Option A is correct as avoiding foods that cause gas can help manage colostomy-related symptoms. Option C is correct as using a skin barrier helps protect the skin around the stoma. Option D is correct as emptying the colostomy bag when it is one-third full helps prevent leakage and discomfort.

2. An adolescent tells the school nurse that she is pregnant. Her last menstrual period was 4 months ago. She has not received any medical care. She smokes but denies any other substance use. What is the priority nursing action?

• A. notify her parents
• B. refer her for prenatal care
• C. teach breastfeeding methods
• D. offer nutritional instructions

Correct answer: B

Rationale: The correct answer is to refer her for prenatal care. Prenatal care is essential to monitor the health of both the mother and the fetus during pregnancy. While notifying her parents may be important for support and involvement, the priority is ensuring the adolescent receives medical care. Teaching breastfeeding methods and offering nutritional instructions are important but are not the immediate priority in this situation where prenatal care is urgently needed.

3. The nurse is preparing an orientation class for new employees at an inner-city clinic that serves a low-income population. Which information should the nurse include in the presentation to these new employees?

• A. A lack of transportation is the major impediment for the clinic's clients.
• B. Basic physiological needs are likely to be unmet in this clinic's client population.
• C. Printed material is less effective for this population that has limited reading skills.
• D. A group education class is often poorly attended by non-compliant clients.

Correct answer: A

Rationale: The correct answer is A. Addressing transportation issues is crucial when working with low-income populations as lack of transportation can be a significant barrier to accessing healthcare services. This information is important for new employees to understand the challenges faced by the clinic's clients and to strategize ways to overcome this barrier. Choices B, C, and D are incorrect because while they may be relevant considerations, addressing transportation barriers should be a priority given its impact on accessing care for this specific population.

4. 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.

5. A public health nurse is evaluating a program designed to reduce the incidence of diabetes in the community. Which outcome indicates that the program is successful?

• A. increased participation in diabetes education sessions
• B. higher rates of blood glucose monitoring
• C. reduced incidence of diabetes-related complications
• D. greater knowledge of diabetes prevention methods

Correct answer: C

Rationale: The correct answer is C: 'reduced incidence of diabetes-related complications.' This outcome indicates that the program is successful because it shows that individuals are effectively managing their condition, leading to fewer complications. Increased participation in education sessions (choice A) and higher rates of blood glucose monitoring (choice B) are important but are more process indicators rather than direct outcomes of improved health. Greater knowledge of prevention methods (choice D) is beneficial but may not directly reflect a reduction in diabetes incidence or complications.

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