A nurse is teaching a client who speaks a different language than the nurse about medications. Which of the following actions should the nurse take?

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: Changing the facility's vendor for central line products is not a quality improvement strategy. The vendor is not the cause of the infections, but the process of insertion, maintenance, and removal of the central line. The nurse manager should focus on improving the quality of care rather than the quality of products.

Choice B reason: Using resources that identify benchmarks of best practices is a quality improvement strategy. The nurse manager should compare the facility's performance with the standards and guidelines of evidence-based practice, such as the Centers for Disease Control and Prevention (CDC) or the Institute for Healthcare Improvement (IHI). The nurse manager should also implement interventions to reduce the infection rate, such as staff education, audits, and feedback.

Choice C reason: Identifying the staff caring for clients who acquire an infection is not a quality improvement strategy. The nurse manager should not single out or blame the staff for the infections, but rather involve them in the quality improvement process. The nurse manager should foster a culture of safety and teamwork, and encourage the staff to report and prevent errors.

Choice D reason: Reporting the incidence of infection to the health department is not a quality improvement strategy. The nurse manager should report the infection rate as required by law, but this does not improve the quality of care. The nurse manager should use the data to identify the gaps and areas of improvement, and monitor the outcomes of the quality improvement plan.