Nursing Elites

1. Following a classic cholecystectomy resection for multiple stones, the PACU nurse observes serosanguinous drainage on the dressing. The most appropriate intervention is to:

• A. notify the physician of the drainage.
• B. change the dressing.
• C. reinforce the dressing.
• D. apply an abdominal binder

Correct answer: reinforce the dressing.

Rationale: Serosanguinous drainage is expected after a classic cholecystectomy resection. The appropriate intervention is to reinforce the dressing to maintain pressure and promote clot formation. Changing the dressing prematurely increases the risk of infection as it disturbs the wound. Applying an abdominal binder is not indicated as it can interfere with visualizing the dressing and assessing for any signs of bleeding or infection. Notifying the physician is not necessary at this point unless there are signs of excessive bleeding or other concerning symptoms.

2. During surgery, it is found that a client with adenocarcinoma of the rectum has positive peritoneal lymph nodes. What is the next most likely site of metastasis?

• A. brain
• B. bone
• C. liver
• D. mediastinum

Correct answer: C

Rationale: In cases of adenocarcinoma of the rectum with positive peritoneal lymph nodes, the most likely site of metastasis is the liver. Colon tumors commonly spread through the lymphatics and portal vein to the liver. While metastasis to the brain, bone, or mediastinum is possible, the liver is typically the first to be affected due to the anatomical pathways involved in colorectal cancer metastasis. Therefore, the correct answer is the liver. Metastasis to the brain, bone, or mediastinum would be less likely at this stage of colorectal cancer progression.

3. What is the role of an incident report in risk management?

• A. To provide liability protection.
• B. To provide data for analysis by a risk manager to determine how future problems can be avoided.
• C. To discipline staff for errors.
• D. All of the above.

Correct answer: To provide data for analysis by a risk manager to determine how future problems can be avoided.

Rationale: The correct answer is B. Incident reports play a crucial role in risk management by providing data for analysis to prevent future problems. They are not primarily for liability protection (A) or disciplining staff (C). Therefore, choice B is the most appropriate answer. Choosing option D is incorrect because incident reports do not solely exist for all the mentioned purposes, but primarily to provide data for analysis and preventive actions.

4. Which of the following conditions has a severe complication of respiratory failure?

• A. Bell’s palsy
• B. Guillain-Barré syndrome
• C. Trigeminal neuralgia
• D. Tetanus

Correct answer: Guillain-Barré syndrome

Rationale: Guillain-Barré syndrome is characterized by a severe complication of respiratory failure due to the involvement of the peripheral nerves that control breathing. While Bell’s palsy, trigeminal neuralgia, and tetanus are also conditions affecting peripheral nerves, they do not typically lead to respiratory failure like Guillain-Barré syndrome. Bell’s palsy causes facial muscle weakness, trigeminal neuralgia results in severe facial pain, and tetanus leads to muscle stiffness and spasms, but none of these conditions directly involve respiratory failure.

5. Which of the following microorganisms are considered normal body flora?

• A. staphylococcus on the skin
• B. streptococcus in the nares
• C. candida albicans in the vagina
• D. pseudomonas in the blood

Correct answer: staphylococcus on the skin

Rationale: Staphylococcus is considered normal body flora as it is commonly found on the skin, being a part of the normal microbiota. While streptococcus in the nares can be part of the normal flora of the upper respiratory tract, it is not as common or as widespread as staphylococcus on the skin. Candida albicans in the vagina is not considered normal flora; it is a common opportunistic pathogen in the vagina. Pseudomonas in the blood is also not considered normal body flora; pseudomonas is not typically found in the blood as part of the normal microbiota.

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