Nursing Elites

1. Which assessment information will be most important for the nurse to report to the healthcare provider about a patient with acute cholecystitis?

• A. The patient's urine is bright yellow
• B. The patient's stools are tan colored
• C. The patient has increased pain after eating
• D. The patient complains of chronic heartburn

Correct answer: B

Rationale: The correct answer is that the patient's stools are tan colored. Tan or grey stools indicate biliary obstruction, which requires rapid intervention to resolve in a patient with acute cholecystitis. This change in stool color is a critical sign that the healthcare provider needs to be informed about promptly. The other choices are less concerning and may be common symptoms in patients with acute cholecystitis, but tan-colored stools specifically indicate a potential serious complication that warrants immediate attention.

2. A client using an intraaural hearing aid experiences whistling after placement. What is the nurse's next action?

• A. Try to reposition the hearing aid
• B. Change the batteries
• C. Remove the device and have it cleaned
• D. Notify the physician that the hearing aid is not working

Correct answer: A

Rationale: An intraaural hearing aid, also known as an in-the-ear hearing aid, is placed in the ear canal. Whistling after placement indicates improper positioning of the device. The correct action for the nurse is to try repositioning the hearing aid to eliminate the whistling. Changing the batteries is not necessary for addressing whistling. Removing the device to clean it is not the immediate action needed for whistling. Notifying the physician is premature without attempting to reposition the hearing aid first.

3. The healthcare provider is reviewing the lab results of a patient who has presented in the Emergency Room. The lab results show that the troponin T value is at 5.3 ng/mL. Which of these interventions, if not already completed, would take priority over the others?

• A. Place the patient in a 90-degree position
• B. Assess whether the patient is taking diuretics
• C. Obtain and attach defibrillator leads
• D. Assess the patient's last ejection fraction

Correct answer: C

Rationale: In this scenario, the elevated Troponin T level indicates cardiac damage, possibly due to a myocardial infarction. A Troponin T value of 5.3 ng/mL is significantly elevated (normal levels are below 0.2 ng/mL), suggesting acute cardiac injury. Given the setting of an Emergency Room and the critical nature of the situation, the priority intervention should be to obtain and attach defibrillator leads. Elevated Troponin T levels can indicate a higher risk of arrhythmias, including ventricular fibrillation, which can lead to sudden cardiac arrest. Defibrillator leads are essential for monitoring the patient's cardiac rhythm and readiness for immediate defibrillation if necessary. Placing the patient in a 90-degree position (Choice A) or assessing diuretic use (Choice B) are not immediate priorities in this critical situation. Additionally, assessing the patient's last ejection fraction (Choice D) is important but not as urgent as preparing for potential life-threatening arrhythmias requiring defibrillation.

4. A 67-year-old male patient with acute pancreatitis has a nasogastric (NG) tube to suction and is NPO. Which information obtained by the nurse indicates that these therapies have been effective?

• A. Bowel sounds are present.
• B. Grey Turner sign resolves.
• C. Electrolyte levels are normal.
• D. Abdominal pain is decreased.

Correct answer: D

Rationale: The correct answer is 'Abdominal pain is decreased.' In a patient with acute pancreatitis, the goal of using an NG tube for suction and keeping the patient NPO is to decrease the release of pancreatic enzymes and alleviate pain. Therefore, a decrease in abdominal pain would indicate the effectiveness of these therapies. Bowel sounds being present do not necessarily indicate treatment effectiveness, as they can still be present even if the therapies are not fully effective. Normal electrolyte levels are important but do not directly reflect the efficacy of NG suction and NPO status. The resolution of Grey Turner sign, a bruising over the flanks associated with pancreatitis, is a late and non-specific finding and waiting for it to resolve is not a reliable indicator of treatment effectiveness.

5. The nurse provides home care instructions to the parents of a child with celiac disease. The nurse should teach the parents to include which food item in the child's diet?

• A. Rice
• B. Oatmeal
• C. Rye toast
• D. White bread

Correct answer: A

Rationale: In celiac disease, individuals are intolerant to gluten found in wheat, barley, rye, and oats. Therefore, it is crucial to eliminate these grains from the diet. Rice, corn, or millet are safe alternatives for individuals with celiac disease. Oatmeal is generally avoided unless specifically labeled as gluten-free due to possible cross-contamination. Rye toast and white bread contain gluten and should be avoided in celiac disease. Vitamin supplements may also be necessary to address deficiencies caused by dietary restrictions.

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