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. The nurse is caring for a patient who 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 regularly and avoid individuals who are ill.

Correct answer: D

Rationale: The correct answer is D: 'Wash hands regularly and avoid individuals who are ill.' After a splenectomy, the patient is at an increased risk of infection, particularly from gram-positive bacteria. Proper hand hygiene and avoiding contact with sick individuals are crucial to prevent infections. Choices A, B, and C are incorrect because checking for swollen lymph nodes, watching for excessive bleeding or bruising, and taking iron supplements are not specifically related to the increased infection risk post-splenectomy.

3. A healthcare provider reviews the laboratory data for an older patient. The healthcare provider would be most concerned about which finding?

• A. Hematocrit of 35%
• B. Hemoglobin of 11.8 g/dL
• C. Platelet count of 400,000/μL
• D. White blood cell (WBC) count of 2800/μL

Correct answer: D

Rationale: A low white blood cell (WBC) count in an older patient is concerning as it indicates a potential compromise in the patient's immune function. White blood cells are crucial for fighting infections and a low count could lead to an increased risk of infections. Hematocrit, hemoglobin, and platelet count are important parameters to assess, but a low WBC count takes priority in this case due to its direct impact on immune health.

4. Which patient should the nurse assign as the roommate for a patient who has aplastic anemia?

• A. A patient with chronic heart failure
• B. A patient who has viral pneumonia
• C. A patient who has right leg cellulitis
• D. A patient with multiple abdominal drains

Correct answer: A

Rationale: The correct answer is A because patients with aplastic anemia are at risk for infection due to low white blood cell production. Assigning a roommate with viral pneumonia (choice B), cellulitis (choice C), or multiple abdominal drains (choice D) could expose the patient with aplastic anemia to potential infectious agents, which could further compromise their health.

5. During a physical assessment, the nurse examines the lymph nodes of a patient. Which assessment finding would be of most concern to the nurse?

• A. A 2-cm nontender supraclavicular node
• B. A 1-cm mobile and nontender axillary node
• C. An inability to palpate any superficial lymph nodes
• D. Firm inguinal nodes in a patient with an infected foot

Correct answer: A

Rationale: The correct answer is A. A 2-cm nontender supraclavicular node is of most concern because enlarged and nontender nodes in this area are highly suggestive of malignancies such as lymphoma. Choice B is less concerning as a 1-cm mobile and nontender axillary node is usually benign. Choice C, an inability to palpate any superficial lymph nodes, could be due to factors like obesity or edema, but it is not necessarily a cause for immediate concern. Choice D, firm inguinal nodes in a patient with an infected foot, may indicate a local reaction to infection rather than a systemic issue related to malignancy.

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