ATI_NUR 275 Competencies for Contemporary Nursing Practice

D. Osteoporosis
Osteoporosis is an expected long-term complication in clients with chronic respiratory acidosis from COPD. Chronic CO₂ retention leads to acidosis, and the kidneys compensate by excreting hydrogen ions while retaining bicarbonate. Over time, buffering acids leads to increased calcium loss from bones, contributing to bone demineralization. In addition, many COPD clients require long-term corticosteroid therapy, further increasing the risk of osteoporosis and bone fractures.

D. "Severe nearsightedness"
Severe nearsightedness (myopia) is a known risk factor for glaucoma, particularly open-angle glaucoma. Myopia affects the structure of the eye, increasing susceptibility to damage to the optic nerve due to increased intraocular pressure. Clients with high myopia require routine eye exams to detect early signs.

B. "It facilitates the client's deep breathing."
Following CABG surgery, maintaining adequate ventilation and preventing pulmonary complications such as atelectasis, pneumonia, and hypoxemia is critical. Effective pain control allows the client to take deep breaths, cough, and participate in pulmonary hygiene (e.g., incentive spirometry). Without adequate analgesia, the client may splint their chest to avoid pain, resulting in shallow breathing and ineffective lung expansion, significantly increasing postoperative respiratory risk.

A. Alcohol use disorder
Active substance use disorder, including alcohol use disorder, is a contraindication to kidney transplantation. Successful transplant requires strict lifelong adherence to immunosuppressive medications and follow-up care; substance misuse increases risk of nonadherence and poor outcomes. Clients must demonstrate sustained sobriety and rehabilitation before being considered candidates. Transplant programs typically require documentation of treatment participation and a period of abstinence prior to listing.

A. Atropine
Atropine is the first-line medication for symptomatic bradycardia following a return of circulation. It works by blocking vagal stimulation of the heart, resulting in increased heart rate and improved cardiac output. In post–cardiac arrest care, symptomatic bradycardia can compromise perfusion and oxygen delivery to vital organs. Prompt atropine administration supports stabilization while advanced interventions and pacing, if needed, are prepared.

B. Amylase
In acute pancreatitis, pancreatic enzymes such as amylase become significantly elevated due to inflammation and autodigestion of the pancreatic tissue. Amylase levels typically rise within hours of pancreatitis onset and serve as a key diagnostic indicator alongside elevated lipase. Elevated amylase confirms enzyme leakage into the bloodstream as the pancreas becomes inflamed and damaged.

A. History of breast cancer
Hormone therapy is contraindicated for clients with a history of breast cancer because estrogen can stimulate the growth of hormone-sensitive tumors and increase the risk of recurrence. HT is avoided to protect the client's long-term health and prevent cancer progression.

B. A self-report pain rating scale
A self-report pain scale is always the first and most reliable method to assess pain, even in clients with expressive aphasia, as long as they can understand and respond non-verbally. Tools such as numeric scales, picture charts, or communication boards allow the client to indicate pain level. Expressive aphasia affects verbal expression but not necessarily comprehension or ability to point, gesture, or use alternative communication methods, making self-report the priority.

C. Autonomy
Autonomy is the ethical principle that supports a client's right to make decisions about their own care, including the refusal or withdrawal of treatment, even if it results in death. Because this client is alert, oriented, and capable of informed decision-making, forcing continued ventilation violates their personal right to control their own medical choices and bodily integrity.