The healthcare provider attaches a pulse oximeter to a client's fingers and obtains an oxygen saturation reading of 91%. Which assessment finding most likely contributes to this reading?

Correct Answer: B

Rationale: Edema in the fingers and hands can impede the proper functioning of the pulse oximeter, leading to a falsely low oxygen saturation reading. Edema alters the transmission of light through the tissues, affecting the accuracy of the measurement. Therefore, the presence of edema in the fingers and hands is the most likely factor contributing to the low oxygen saturation reading of 91%.

Correct Answer: B

Rationale: In this situation, providing space and privacy for the family allows them to openly discuss their concerns regarding the client's discharge. It respects the family's need for support, communication, and involvement in the decision-making process, ultimately fostering a more effective and compassionate care environment.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Rely on cultural norms as the basis for providing healthcare for this client. This is the most appropriate action because it acknowledges the importance of cultural competence in nursing care. Understanding and respecting the cultural background of a patient is essential in providing effective and holistic healthcare. Option A is incorrect because just providing an interpreter does not address the broader cultural considerations that should be taken into account. While language translation is important, it is not sufficient to ensure culturally sensitive care. Option B is incorrect as commending the client for patience does not directly address the cultural aspects that may impact the patient's care and experience during the admission process. Option C is incorrect as assuming the need for a chaplain based solely on the patient's cultural background is not appropriate. It is important to respect the client's beliefs and preferences regarding spiritual care rather than making assumptions based on ethnicity. In an educational context, it is crucial for nursing students to understand the significance of cultural competence in nursing practice. Providing culturally sensitive care leads to better patient outcomes, increased trust between the healthcare provider and patient, and overall improved quality of care. Nurses should be equipped with the knowledge and skills to effectively assess and address the cultural needs of diverse patient populations to deliver patient-centered care.

Correct Answer: C

Rationale: In teaching the correct administration of subcutaneous (subQ) injections, the healthcare professional should emphasize option C: Pinch the skin before inserting the needle. This instruction is crucial as pinching the skin helps to lift the subcutaneous tissue away from the muscle, ensuring that the medication is delivered into the fatty layer beneath the skin. By pinching the skin, the risk of injecting the medication into the muscle is minimized, which can lead to discomfort and potential complications. Option A is incorrect because subQ injections are typically administered at a 45-degree angle for thinner individuals or a 90-degree angle for those with more adipose tissue. Inserting the needle at a 90-degree angle can lead to injecting the medication into the muscle instead of the subcutaneous layer. Option B is incorrect because aspirating for blood return is not necessary for subQ injections since the subcutaneous tissue has fewer blood vessels compared to the muscle tissue. Aspirating can increase the risk of tissue trauma and discomfort for the patient. Option D is incorrect because massaging the site after administering a subQ injection is not recommended. Massaging can cause discomfort, bruising, or the dispersion of the medication beyond the intended area. In an educational context, understanding the correct technique for subQ injections is essential for nursing students and healthcare professionals to ensure safe and effective medication administration. Emphasizing the importance of correct injection angles, skin preparation, and post-injection care is vital for providing quality patient care and minimizing complications.

Correct Answer: A

Rationale: Monitoring urine output is the most direct way to assess kidney function as it provides crucial information about the kidneys' ability to filter waste and produce urine. Changes in urine output can indicate potential issues with kidney function, such as decreased filtration or impaired excretion of waste products.