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A client with a history of asthma is admitted with shortness of breath. Which finding requires immediate intervention?
- A. Increased respiratory rate.
- B. Absence of breath sounds.
- C. Expiratory wheezes.
- D. Productive cough with green sputum.
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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An older female client tells the home health nurse that she has no money, and since she does not deserve to eat, she has not asked anyone to bring her food. What information is most important for a nurse to obtain?
- A. client's thoughts about wanting to hurt herself
- B. medication history for antipsychotic agents
- C. availability of family members to provide meals
- D. community resources to provide financial aid
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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: Failed to generate a rationale of 500+ characters after 5 retries.
A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with pneumonia. Which finding requires immediate intervention?
- A. Oxygen saturation of 88%
- B. Respiratory rate of 24 breaths per minute
- C. Heart rate of 90 beats per minute
- D. Productive cough with green sputum
Correct Answer: D
Rationale: In a client with COPD admitted with pneumonia, a productive cough with green sputum indicates a potential bacterial infection. Green sputum is commonly associated with bacterial pneumonia, which requires immediate intervention with appropriate antibiotics. Monitoring oxygen saturation, respiratory rate, and heart rate are essential in COPD patients, but the presence of green sputum suggests an urgent need for targeted treatment to address the underlying infection. Oxygen saturation of 88% is concerning but may not directly indicate the need for immediate intervention in the absence of other critical symptoms. Respiratory rate of 24 breaths per minute and a heart rate of 90 beats per minute are within normal limits and may not be indicative of an acute issue requiring immediate intervention in this context.
A public health nurse is planning a campaign to increase immunization rates among children in a low-income community. Which intervention should the nurse prioritize?
- A. provide free immunizations at local schools
- B. create educational materials about vaccine safety
- C. organize a community forum to discuss immunization concerns
- D. partner with local media to promote the importance of vaccines
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A school nurse is organizing a vaccination clinic for middle school students. Which vaccine is most important for the nurse to include?
- A. hepatitis B
- B. tetanus, diphtheria, and pertussis (Tdap)
- C. varicella
- D. measles, mumps, and rubella (MMR)
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.