Nursing Elites

1. A 67-year-old male patient with acute pancreatitis has a nasogastric (NG) tube to suction and is NPO. Which information obtained by the nurse indicates that these therapies have been effective?

• A. Bowel sounds are present.
• B. Grey Turner sign resolves.
• C. Electrolyte levels are normal.
• D. Abdominal pain is decreased.

Correct answer: D

Rationale: The correct answer is 'Abdominal pain is decreased.' In a patient with acute pancreatitis, the goal of using an NG tube for suction and keeping the patient NPO is to decrease the release of pancreatic enzymes and alleviate pain. Therefore, a decrease in abdominal pain would indicate the effectiveness of these therapies. Bowel sounds being present do not necessarily indicate treatment effectiveness, as they can still be present even if the therapies are not fully effective. Normal electrolyte levels are important but do not directly reflect the efficacy of NG suction and NPO status. The resolution of Grey Turner sign, a bruising over the flanks associated with pancreatitis, is a late and non-specific finding and waiting for it to resolve is not a reliable indicator of treatment effectiveness.

2. Using the illustrated technique, the healthcare provider is assessing for which finding in a patient with chronic obstructive pulmonary disease (COPD)?

• A. Hyperresonance
• B. Tripod positioning
• C. Accessory muscle use
• D. Reduced chest expansion

Correct answer: D

Rationale: The technique for palpation for chest expansion is shown in the illustrated technique. Reduced chest expansion would be noted on palpation of a patient's chest with COPD. Hyperresonance would be assessed through percussion, not palpation. Accessory muscle use and tripod positioning would be assessed by inspection, not palpation.

3. When caring for a patient with Parkinson's Disease, which of the following practices would not be included in the care plan?

• A. Decrease the calorie content of daily meals to avoid weight gain
• B. Allow the patient extra time to respond to questions and perform ADLs
• C. Use thickened liquids and a soft diet
• D. Encourage the patient to hold the spoon when eating

Correct answer: A

Rationale: The correct answer is to decrease the calorie content of daily meals to avoid weight gain. Patients with Parkinson's Disease often experience dysphagia (difficulty swallowing) and muscle rigidity, which can lead to weight loss. Therefore, increasing calorie intake is essential to meet their nutritional needs. Choice A is incorrect because reducing calories can worsen malnutrition in these patients. Choices B, C, and D are appropriate interventions for patients with Parkinson's Disease. Allowing extra time for tasks, using thickened liquids and a soft diet for swallowing difficulties, and encouraging self-feeding promote independence and safety in eating.

4. The nurse prepares a patient with a left-sided pleural effusion for a thoracentesis. How should the nurse position the patient?

• A. Supine with the head of the bed elevated 30 degrees
• B. In a high-Fowler's position with the left arm extended
• C. On the right side with the left arm extended above the head
• D. Sitting upright with the arms supported on an overbed table

Correct answer: D

Rationale: The correct position for a patient with a left-sided pleural effusion undergoing thoracentesis is sitting upright with the arms supported on an overbed table. This position helps increase lung expansion, allows fluid to collect at the lung bases, and expands the intercostal space making access to the pleural space easier. Placing the patient supine, in a high-Fowler's position, or on the right side with the left arm extended above the head could increase the work of breathing for the patient and complicate the thoracentesis procedure for the healthcare provider.

5. The nurse is caring for a 73-year-old man with cirrhosis. Which data obtained by the nurse during the assessment will be of most concern?

• A. The patient complains of right upper-quadrant pain upon palpation.
• B. The patient's hands flap back and forth when the arms are extended.
• C. The patient has ascites and a 2-kg weight gain from the previous day.
• D. The patient's skin has multiple spider-shaped blood vessels on the abdomen.

Correct answer: B

Rationale: The most concerning data obtained by the nurse is the patient's hands flapping back and forth when the arms are extended, indicating asterixis, which is associated with hepatic encephalopathy. This condition can progress to hepatic coma and requires immediate attention. The presence of spider angiomas and right upper-quadrant abdominal pain are common findings in cirrhosis and do not warrant urgent intervention. Although ascites and weight gain suggest the need for treatment, they are not as alarming as the neurologic manifestations seen in hepatic encephalopathy.

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