A healthcare professional assesses a client who is experiencing an acute asthma attack. Which assessment finding requires immediate intervention?

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Question 1 of 5

A healthcare professional assesses a client who is experiencing an acute asthma attack. Which assessment finding requires immediate intervention?

Correct Answer: D

Rationale: The correct answer is D: Silent chest. This finding indicates severe airway obstruction and impending respiratory failure, requiring immediate intervention to prevent respiratory arrest. Silent chest means minimal or absent breath sounds, suggesting no air movement, which is a critical emergency situation. Wheezing (A), increased respiratory rate (B), and use of accessory muscles (C) are common in asthma attacks but do not indicate as severe a condition as a silent chest. Monitoring and addressing a silent chest promptly is crucial in managing acute asthma exacerbations.

Question 2 of 5

A client who had coronary artery bypass grafting yesterday needs care. What actions can the nurse delegate to the unlicensed assistive personnel (UAP)? (SATA)

Correct Answer: C

Rationale: The correct answer is C because ensuring the client wears TED hose or sequential compression devices is within the scope of practice for UAP. This task does not require critical thinking or assessment skills, making it suitable for delegation. Administering antibiotics (A) and encouraging spirometer use (B) require clinical judgment and assessment skills, which UAP do not possess. Having the client rate pain and report to the nurse (D) involves subjective assessment and potential interventions, making it inappropriate for delegation to UAP.

Question 3 of 5

A client who is interested in smoking cessation receives teaching from a nurse. Which statements should the nurse include in this teaching? (Select ONE that does not apply)

Correct Answer: C

Rationale: The correct answer is C: Identify reasons for quitting smoking. This should not be included in the teaching because the client should already have identified their reasons for quitting before receiving the teaching. The client should have a clear understanding of why they want to quit smoking before seeking help. Choices A and B are correct as they provide practical tips to distract from smoking and avoid unhealthy behaviors. Choice D is also correct as making a list of reasons can help reinforce motivation.

Question 4 of 5

A client is interested in smoking cessation. Which statements should the nurse include in this client's teaching? (Select ONE that does not apply)

Correct Answer: D

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Question 5 of 5

The client's potassium level is 6.7 mEq/L. Which intervention should you delegate to the student nurse under your supervision?

Correct Answer: C

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

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