Nursing Elites

1. After a bronchoscopy, what is the most appropriate intervention for a patient with a chronic cough?

• A. Elevate the head of the bed to 80 to 90 degrees.
• B. Keep the patient NPO until the gag reflex returns.
• C. Place the patient on bed rest for at least 4 hours after bronchoscopy.
• D. Notify the health care provider about blood-tinged mucus.

Correct answer: B

Rationale: The correct intervention is to keep the patient NPO until the gag reflex returns after a bronchoscopy. This is important because a local anesthetic is used during the procedure to suppress the gag and cough reflexes. Monitoring the return of these reflexes helps prevent the risk of aspiration and ensures the patient can safely resume oral intake. While blood-tinged mucus can occur after bronchoscopy, it is a common occurrence and not a cause for immediate concern. Placing the patient on bed rest for an extended period is unnecessary, and elevating the head of the bed to a high-Fowler's position is not specifically required post-bronchoscopy.

2. A nurse is assessing a client who is post-op day #3 after an abdominal hernia repair. After a bout of harsh coughing, the client states, 'it feels like something gave way.' The nurse assesses his abdomen and notes an evisceration from the surgical site. What is the next action of the nurse?

• A. Turn the client on his side
• B. Push the abdominal contents back inside the wound using sterile gloves
• C. Ask the client to take a breath and hold it
• D. Cover the intestine with sterile saline dressings

Correct answer: D

Rationale: A wound evisceration occurs when the edges of an abdominal wound separate, allowing the coils of the intestine to protrude outside of the body. The nurse should notify the physician at once if this occurs. While waiting for treatment, the nurse should cover the intestines with sterile gauze soaked in saline. Turning the client on his side or asking the client to take a breath and hold it are not appropriate actions in this situation. Pushing the abdominal contents back inside the wound using sterile gloves can lead to infection and is not within the nurse's scope of practice.

3. The healthcare provider is managing a 20 lbs (9 kg) 6-month-old with a 3-day history of diarrhea, occasional vomiting, and fever. Peripheral intravenous therapy has been initiated, with 5% dextrose in 0.33% normal saline with 20 mEq of potassium per liter infusing at 35 ml/hr. Which finding should be immediately reported to the healthcare provider?

• A. 3 episodes of vomiting in 1 hour.
• B. Periodic crying and irritability.
• C. Vigorous sucking on a pacifier.
• D. No measurable voiding in 4 hours.

Correct answer: D

Rationale: The critical finding that should be reported immediately to the healthcare provider is 'No measurable voiding in 4 hours.' This finding raises concerns about possible hyperkalemia, which can result from continued potassium administration and a decrease in urinary output. Hyperkalemia can lead to serious complications, including cardiac arrhythmias. The management of acute hyperkalemia involves interventions such as administering calcium to protect the heart, shifting potassium into cells, and enhancing potassium elimination from the body. The other choices do not indicate an urgent issue that requires immediate attention. Three episodes of vomiting in 1 hour can be concerning but may not be as immediately critical as the risk of hyperkalemia. Periodic crying and irritability are common in infants and may not indicate a severe complication. Vigorous sucking on a pacifier is a normal behavior in infants and does not signal a medical emergency.

4. In a pediatric clinic, a nurse is assessing a child recently diagnosed with cystic fibrosis. Which of the following later findings of this disease would the nurse not expect to see at this time?

• A. Positive sweat test
• B. Bulky greasy stools
• C. Moist, productive cough
• D. Meconium ileus

Correct answer: C

Rationale: In a child newly diagnosed with cystic fibrosis (CF), noisy respirations and a dry, non-productive cough are typically the first respiratory signs to appear. The other options, including a positive sweat test, bulky greasy stools, and meconium ileus, are among the earliest findings of CF. CF is a genetic condition that affects the production of mucus, sweat, saliva, and digestive juices. Due to a defective gene, these secretions become thick and sticky instead of thin and slippery, leading to blockages in various passageways, especially in the pancreas and lungs. Respiratory failure is a severe consequence of CF, making it crucial to monitor respiratory symptoms closely in affected individuals. Therefore, a moist, productive cough would not be an expected finding in a newly diagnosed child with CF.

5. When administering a-interferon and ribavirin (Rebetol) to a patient with chronic hepatitis C, the nurse should monitor for which complication?

• A. Leukopenia.
• B. Hypokalemia.
• C. Polycythemia.
• D. Hypoglycemia.

Correct answer: B

Rationale: When administering a-interferon and ribavirin (Rebetol) for chronic hepatitis C, the nurse should monitor for hypokalemia. This combination therapy is known to cause leukopenia, not polycythemia or hypoglycemia. Hypokalemia is a common electrolyte imbalance that can occur with these medications, making it the correct answer to monitor for in this case.

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