A nurse in a clinic is teaching a newly licensed nurse about sexually transmitted infections. The nurse should instruct the newly licensed nurse to report which of the following infections to the health department?

Choice A reason: Calling the provider if you note clubbing of the client's fingernails is not an instruction the charge nurse should include in the teaching. This is an unnecessary and inappropriate action, as clubbing is a chronic and irreversible sign of hypoxia that does not require immediate intervention. The nurse should document the finding and monitor the client's respiratory status.

Choice B reason: Having an assistive personnel ambulate the client just before meals is not an instruction the charge nurse should include in the teaching. This is a harmful and contraindicated action, as ambulation can increase the client's oxygen demand and cause dyspnea and fatigue. The nurse should schedule the client's activity and rest periods around the meals and provide supplemental oxygen as prescribed.

Choice C reason: Notifying the charge nurse if you observe that the client has distended neck veins is an instruction the charge nurse should include in the teaching. This is a necessary and appropriate action, as distended neck veins can indicate right-sided heart failure, which is a complication of COPD. The nurse should report the finding and assess the client for other signs of fluid overload, such as edema, weight gain, and crackles.

Choice D reason: Maintaining the client's oxygen saturation level above 95 percent is not an instruction the charge nurse should include in the teaching. This is an unrealistic and potentially harmful goal, as clients with COPD usually have lower oxygen saturation levels due to chronic hypoxia. The nurse should maintain the client's oxygen saturation level at the prescribed range, which is typically between 88 and 92 percent.

Choice A reason: Providing coverage for the nurses' breaks is a possible action that the charge nurse can take, but it is not the first one. The charge nurse should first assess the situation and identify the factors that are preventing the nurses from taking their breaks.

Choice B reason: Reviewing facility policies for taking scheduled breaks is an important action that the charge nurse can take, but it is not the first one. The charge nurse should first communicate with the nurses and understand their perspectives and needs.

Choice C reason: Determining the reasons the nurses are not taking scheduled breaks is the first action that the charge nurse should take. This will help the charge nurse to address the root cause of the problem and provide appropriate support and guidance to the nurses.

Choice D reason: Discussing time management strategies with the nurses is a helpful action that the charge nurse can take, but it is not the first one. The charge nurse should first determine if the nurses are facing any barriers or challenges that are affecting their ability to take their breaks.