Nursing Elites

1. The nurse recognizes that teaching a 44-year-old woman following a laparoscopic cholecystectomy has been effective when the patient states which of the following?

• A. I can expect yellow-green drainage from the incision for a few days.
• B. I can remove the bandages on my incisions tomorrow and take a shower.
• C. I should plan to limit my activities and not return to work for 4 to 6 weeks.
• D. I will always need to maintain a low-fat diet since I no longer have a gallbladder.

Correct answer: B

Rationale: The correct answer is, 'I can remove the bandages on my incisions tomorrow and take a shower.' After a laparoscopic cholecystectomy, patients have Band-Aids over the incisions and can typically remove the bandages the next day. Patients are usually discharged the same or next day and have minimal restrictions on their daily activities. Yellow-green drainage from the incision would be abnormal, requiring the patient to contact their healthcare provider. While a low-fat diet may be recommended initially after surgery, it is not a lifelong requirement, as the body can adjust to the absence of the gallbladder over time. Choice A is incorrect as abnormal drainage should be reported. Choice C is incorrect as most patients can resume normal activities within a few days to a week. Choice D is incorrect as maintaining a low-fat diet is not a lifelong necessity after a cholecystectomy.

2. When assessing the respiratory system of an older patient, which finding indicates that the nurse should take immediate action?

• A. Weak cough effort
• B. Barrel-shaped chest
• C. Dry mucous membranes
• D. Bilateral crackles at lung bases

Correct answer: D

Rationale: Bilateral crackles at lung bases indicate a potential acute issue like heart failure. Immediate action is necessary in this situation. The nurse should conduct further assessments such as oxygen saturation and inform the healthcare provider promptly. A barrel-shaped chest and hyperresonance to percussion are typical signs of aging and do not require immediate action. A weak cough effort is common in older patients due to age-related changes, and dry mucous membranes are also expected in older individuals. While these findings may warrant further evaluation, they do not demand immediate action like bilateral crackles at lung bases.

3. When supporting the psychosocial needs of a client experiencing negative side effects associated with chemotherapy, which intervention is most appropriate?

• A. Read the client's discharge instructions well in advance of dismissal
• B. Provide medications to reduce nausea and vomiting
• C. Give simple instructions about self-care while in the hospital
• D. Determine the levels of support from significant others

Correct answer: D

Rationale: When a client is experiencing negative side effects associated with chemotherapy, addressing their psychosocial needs is crucial. One effective intervention is to determine the levels of support from significant others. This involves assessing the family, spouse, or friends who can provide help and support to the client when healthcare providers are not present. By identifying and organizing these resources, the nurse can help alleviate fears about the future, prepare caregivers for the client's needs, and facilitate a smoother transition for the client upon discharge. Reading discharge instructions, providing medications, or giving self-care instructions, although important, do not directly address the psychosocial needs of the client during this challenging time.

4. 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.

5. When assessing a patient being treated for Parkinson's Disease with classic symptoms, the nurse expects to note which assessment finding?

• A. Tremors
• B. Low Urine Output
• C. Exaggerated arm movements
• D. Risk for Falls

Correct answer: A

Rationale: When assessing a patient with Parkinson's Disease, the nurse should expect to note tremors as one of the cardinal signs of the condition. The classic symptoms of Parkinson's Disease include tremors, rigidity, bradykinesia (slow movements), and postural instability. Therefore, choices B, C, and D are incorrect. Low urine output is not a typical assessment finding associated with Parkinson's Disease. Exaggerated arm movements are not characteristic of the usual motor symptoms seen in Parkinson's Disease. While patients with Parkinson's Disease are at an increased risk for falls due to balance and coordination issues, 'Risk for Falls' is not an assessment finding but rather a potential nursing diagnosis based on the assessment findings.

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