Nursing Elites

1. The nurse is caring for a patient post-coronary artery bypass graft procedure who is on a nitroglycerin intravenous drip. The nurse understands the importance of nitroglycerin with this procedure as:

• A. Decreasing myocardial oxygen supply.
• B. Increasing preload.
• C. Decreasing cardiac output.
• D. Decreasing afterload.

Correct answer: D

Rationale: Nitroglycerin is a vasodilator that works by decreasing afterload, which is the pressure the heart must work against to eject blood during systole. By reducing afterload, nitroglycerin helps the heart pump more effectively and decreases the workload on the heart. This results in improved cardiac output and decreased myocardial oxygen demand. Choices A, B, and C are incorrect because nitroglycerin does not decrease myocardial oxygen supply, increase preload, or decrease cardiac output.

2. A patient is being discharged after an emergency splenectomy following a motor vehicle crash. Which instructions should the nurse include in the discharge teaching?

• A. Check frequently for swollen lymph nodes.
• B. Watch for excessive bleeding or bruising.
• C. Take iron supplements to prevent anemia.
• D. Wash hands and avoid individuals who are ill.

Correct answer: D

Rationale: The correct answer is D. After a splenectomy, the patient is at an increased risk of infection, particularly from gram-positive bacteria. Washing hands and avoiding contact with individuals who are ill are crucial to reduce this risk. Choice A is incorrect because checking for swollen lymph nodes is not a priority after a splenectomy. Choice B is incorrect as while bleeding is a concern, it is more immediate post-operatively. Choice C is incorrect as iron supplements do not specifically relate to the risk of infection post-splenectomy.

3. The nurse assesses a patient with pernicious anemia. Which assessment finding would the nurse expect?

• A. Yellow-tinged sclerae
• B. Shiny, smooth tongue
• C. Numbness of the extremities
• D. Gum bleeding and tenderness

Correct answer: C

Rationale: The correct answer is C: Numbness of the extremities. Numbness of the extremities is a common finding in patients with pernicious anemia, which is caused by cobalamin (vitamin B12) deficiency. This deficiency affects the peripheral nervous system, leading to neurological symptoms like numbness and tingling in the extremities. Choices A, B, and D are incorrect: Yellow-tinged sclerae is more indicative of jaundice or liver dysfunction, a shiny smooth tongue is seen in conditions like glossitis, and gum bleeding and tenderness are associated with periodontal disease or vitamin C deficiency, not pernicious anemia.

4. Which laboratory test will the nurse use to determine whether filgrastim (Neupogen) is effective for a patient with acute lymphocytic leukemia who is receiving chemotherapy?

• A. Platelet count
• B. Reticulocyte count
• C. Total lymphocyte count
• D. Absolute neutrophil count

Correct answer: D

Rationale: The correct answer is D, Absolute neutrophil count. Filgrastim (Neupogen) works by stimulating the production and function of neutrophils. Therefore, monitoring the Absolute neutrophil count is crucial to assess the effectiveness of filgrastim in increasing neutrophil levels. Choices A, B, and C are incorrect because platelet count, reticulocyte count, and total lymphocyte count do not directly reflect the effectiveness of filgrastim in increasing neutrophils, which are essential in fighting infections during chemotherapy.

5. The nurse is reviewing laboratory results and notes a patient's activated partial thromboplastin time (aPTT) level of 28 seconds. The nurse should notify the health care provider in anticipation of adjusting which medication?

• A. Aspirin
• B. Heparin
• C. Warfarin
• D. Erythropoietin

Correct answer: B

Rationale: The correct answer is B: Heparin. An activated partial thromboplastin time (aPTT) level of 28 seconds indicates a prolonged time, which is associated with heparin administration. Heparin is an anticoagulant medication that affects the intrinsic pathway of the coagulation cascade, leading to an increased aPTT. Aspirin (choice A) affects platelet aggregation and does not directly impact aPTT. Warfarin (choice C) affects the extrinsic pathway of the coagulation cascade and is monitored using the international normalized ratio (INR), not aPTT. Erythropoietin (choice D) is not related to coagulation parameters.

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