Nursing Elites

1. Which assessment finding would the nurse need to report most quickly to the health care provider regarding a patient with acute pancreatitis?

• A. Nausea and vomiting
• B. Hypotonic bowel sounds
• C. Abdominal tenderness and guarding
• D. Muscle twitching and finger numbness

Correct answer: D

Rationale: The correct answer is muscle twitching and finger numbness. These symptoms indicate hypocalcemia, which can lead to tetany if not promptly addressed with calcium gluconate administration. Nausea and vomiting, hypotonic bowel sounds, and abdominal tenderness and guarding are important findings in acute pancreatitis but do not require the same urgent intervention as hypocalcemia to prevent potential severe complications.

2. Which of the following conditions is a contraindication for performing a diagnostic peritoneal lavage?

• A. A client who is 9 weeks pregnant
• B. A client with a femur fracture
• C. A morbidly obese client
• D. A client with hypertension

Correct answer: C

Rationale: Diagnostic peritoneal lavage is contraindicated in morbidly obese clients due to several reasons. Excess body fat in morbidly obese individuals makes it challenging to locate essential landmarks required for the procedure. Additionally, the equipment utilized for the lavage may not be sized appropriately to accommodate an obese individual. Furthermore, morbid obesity places undue stress on the cardiovascular and respiratory systems, increasing the risk of complications when administering anesthetic agents during the procedure. Therefore, performing a diagnostic peritoneal lavage on a morbidly obese client is not recommended. Choice A, a client who is 9 weeks pregnant, is not a contraindication for diagnostic peritoneal lavage. Pregnancy status alone does not preclude the procedure unless there are specific maternal or fetal concerns. Choice B, a client with a femur fracture, is not a contraindication for diagnostic peritoneal lavage. The presence of a femur fracture does not typically affect the ability to perform this diagnostic procedure. Choice D, a client with hypertension, is not a contraindication for diagnostic peritoneal lavage. Hypertension, while a consideration for anesthesia and surgery, does not directly impact the feasibility of performing a diagnostic peritoneal lavage.

3. Which intervention will the nurse include in the plan of care for a patient diagnosed with a lung abscess?

• A. Teach the patient to avoid using over-the-counter expectorants.
• B. Assist the patient with chest physiotherapy and postural drainage.
• C. Notify the healthcare provider immediately regarding any bloody or foul-smelling sputum.
• D. Teach about the necessity of prolonged antibiotic therapy after discharge from the hospital.

Correct answer: D

Rationale: For a patient diagnosed with a lung abscess, the priority intervention is to educate them about the importance of prolonged antibiotic therapy post-hospital discharge. Long-term antibiotic treatment is crucial for eradicating the infecting organisms in a lung abscess. Chest physiotherapy and postural drainage are not recommended for lung abscess as they can potentially spread the infection. While foul-smelling and bloody sputum are common in lung abscess, immediate notification to the healthcare provider is essential. Avoiding the use of over-the-counter expectorants is not necessary, as expectorants can be used to facilitate coughing and clearing of secretions in this condition.

4. During an intake screening for a patient with hypertension who has been taking ramipril for 4 weeks, which statement made by the patient would be most important for the nurse to pass on to the physician?

• A. ''I get dizzy when I get out of bed.''
• B. ''I'm urinating much more than I used to.''
• C. ''I've been running on the treadmill for 10 minutes each day.''
• D. ''I can't get rid of this cough.''

Correct answer: D

Rationale: The correct answer is ''I can't get rid of this cough.'' Ramipril, an ACE inhibitor, commonly causes a persistent, dry cough as an adverse effect. This symptom can be indicative of bradykinin accumulation caused by ACE inhibitors. It is important for the nurse to inform the physician about this side effect so that a medication change to another class of antihypertensives, such as an ARB, may be considered. Choices A, B, and C are not directly related to the common adverse effects of ramipril and are not as concerning for a patient on this medication.

5. How does shock typically progress?

• A. Compensated to hypotensive shock in hours and hypotensive shock to cardiac arrest in minutes
• B. Compensated to hypotensive shock in minutes and hypotensive shock to cardiac arrest in hours
• C. Hypotensive to compensated shock in hours and compensated shock to cardiac arrest in minutes
• D. Hypotensive to compensated shock in minutes and compensated shock to cardiac arrest in hours

Correct answer: A

Rationale: Shock typically progresses from a compensated state to hypotensive shock over a period of hours. In the compensated phase, the body is trying to maintain perfusion. It is crucial to identify and intervene during this phase to prevent progression to hypotensive shock, where blood pressure drops significantly. If not promptly managed, hypotensive shock can rapidly deteriorate into cardiac arrest in minutes due to inadequate perfusion to vital organs. Choices B, C, and D are incorrect as they do not follow the typical progression of shock stages as seen in clinical practice. Understanding the stages of shock and their timeframes is crucial for early recognition and appropriate intervention to prevent further deterioration.

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