Nursing Elites

1. Which factors will the nurse consider when calculating the CURB-65 score for a patient with pneumonia? (Select one that does not apply)

• A. Age
• B. Blood pressure
• C. Respiratory rate
• D. Oxygen saturation

Correct answer: D

Rationale: The correct answer is 'Oxygen saturation.' When calculating the CURB-65 score for a patient with pneumonia, the factors considered include mental status (confusion), BUN (elevated), blood pressure (decreased), respiratory rate (increased), and age (65 and older). Oxygen saturation is not used in the CURB-65 scoring system. While blood pressure, respiratory rate, and age are factors that are used in the calculation of the CURB-65 score, oxygen saturation is not part of the scoring criteria. Therefore, oxygen saturation is the factor that does not apply when calculating the CURB-65 score.

2. A child is diagnosed with a Greenstick Fracture. Which of the following most accurately describes the broken bone?

• A. compound fracture of the fibula
• B. a partial break in a long bone
• C. fracture of the growth plate of the ulna near the wrist
• D. Colles fracture of the tibia

Correct answer: B

Rationale: A Greenstick Fracture is commonly found in children due to their bones being more flexible. This type of fracture occurs when a bone bends and partially breaks, resembling what happens when a green stick from a tree is bent in half. Therefore, the most accurate description of a Greenstick Fracture is 'a partial break in a long bone.' Choice A, 'compound fracture of the fibula,' is incorrect as a Greenstick Fracture is not a compound fracture. Choice C, 'fracture of the growth plate of the ulna near the wrist,' is incorrect as it describes a different type of fracture. Choice D, 'Colles fracture of the tibia,' is incorrect as it refers to a specific type of fracture in a different bone.

3. A client had a closed reduction of a fractured right wrist followed by the application of a fiberglass cast 12 hours ago. Which finding requires immediate attention?

• A. Capillary refill of fingers on right hand is 3 seconds
• B. Skin warm to touch and normally colored
• C. Client reports prickling sensation in the right hand
• D. Slight swelling of fingers of right hand

Correct answer: C

Rationale: A prickling sensation in the right hand is indicative of compartment syndrome, a serious condition that can lead to tissue damage and impaired circulation. Immediate attention is required to prevent complications. Capillary refill of 3 seconds, warm and normally colored skin, and slight swelling of fingers are expected findings after a closed reduction and casting. These findings do not typically indicate a critical issue and can be managed with routine monitoring.

4. Following mitral valve replacement surgery, a client develops PVCs. The healthcare provider orders a bolus of Lidocaine followed by a continuous Lidocaine infusion at a rate of 2 mg/minute. The IV solution contains 2 grams of Lidocaine in 500 mL of D5W. The infusion pump delivers 60 microdrops/mL. What rate would deliver 4 mg of Lidocaine per minute?

• A. 60 microdrops/minute
• B. 20 microdrops/minute
• C. 30 microdrops/minute
• D. 40 microdrops/minute

Correct answer: A

Rationale: To calculate the rate needed to deliver 4 mg/minute of Lidocaine, first, convert 2 grams to milligrams: 2 grams = 2000 mg. Then, set up a ratio between the total amount of Lidocaine (2000 mg) and the total volume of IV solution (500 mL): 2000 mg / 500 mL = 4 mg / x mL. Solving for x, x = 1 mL. Since the infusion pump delivers 60 microdrops per mL, multiplying by 60 microdrops/mL gives the correct rate of 60 microdrops/minute. This rate ensures the desired 4 mg of Lidocaine is delivered per minute. Choices B, C, and D are incorrect as they do not align with the accurate calculation based on the provided information.

5. The nurse provides discharge instructions to a patient who was hospitalized for pneumonia. Which statement, if made by the patient, indicates a good understanding of the instructions?

• A. I will call the doctor if I still feel tired after a week.
• B. I will continue to do the deep breathing and coughing exercises at home.
• C. I will continue to do the deep breathing and coughing exercises at home.
• D. I'll cancel my chest x-ray appointment if Im feeling better in a couple weeks

Correct answer: C

Rationale: Patients should continue to cough and deep breathe after discharge. Fatigue is expected for several weeks. The Pneumovax and influenza vaccines can be given at the same time in different arms. Explain that a follow-up chest x-ray needs to be done in 6 to 8 weeks to evaluate resolution of pneumonia.

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