A nurse is participating on a committee that is considering the creation of a policy that will allow nurses to remove chest tubes. Which of the following is an appropriate resource for the nurse to consult in planning for this policy?

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: Offering to place the purse in the facility safe is the most appropriate action, as it ensures the security and confidentiality of the client's personal belongings. The nurse should document the items in the purse and obtain the client's signature before placing them in the safe.

Choice B reason: Telling the client to leave her purse in a drawer at the bedside is an inappropriate action, as it does not guarantee the safety of the client's personal belongings. The nurse should not leave the client's purse unattended or in an accessible location.

Choice C reason: Offering to store the purse with the nurse's belongings is an inappropriate action, as it violates the professional boundaries and the facility's policy. The nurse should not mix the client's personal belongings with their own, as it may create confusion or conflict.

Choice D reason: Placing the purse underneath the client's sheet is an inappropriate action, as it does not protect the client's personal belongings from theft or damage. The nurse should not hide the client's purse under the sheet, as it may be forgotten or misplaced.