Nursing Elites

1. 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.

2. A patient is suspected to have sustained a spinal cord injury. What best describes the overarching principles used to guide the care for this type of condition?

• A. Immobilize the cervical area to prevent further injury
• B. Monitor the patient's level of consciousness to prevent neurologic deterioration
• C. Help the patient with activities of daily living and provide emotional and physical support to help them adjust to their injury
• D. Facilitate tissue perfusion to the spinal cord while maintaining airway and breathing

Correct answer: D

Rationale: The correct answer is to facilitate tissue perfusion to the spinal cord while maintaining airway and breathing. In the acute phase of a spinal cord injury, ensuring proper tissue perfusion to the spinal cord is crucial to prevent further damage. Maintaining airway, breathing, and circulation is essential in guiding the overall care for a patient with a spinal cord injury. Choices A, B, and C, while important in certain aspects of care, are not the overarching principles that guide the immediate management of a suspected spinal cord injury.

3. One hour after a thoracotomy, a patient complains of incisional pain at a level 7 (based on a 0 to 10 scale) and has decreased left-sided breath sounds. The pleural drainage system has 100 mL of bloody drainage and a large air leak. Which action is best for the nurse to take next?

• A. Milk the chest tube gently to remove any clots.
• B. Clamp the chest tube momentarily to check for the origin of the air leak.
• C. Assist the patient to deep breathe, cough, and use the incentive spirometer.
• D. Set up the patient-controlled analgesia (PCA) and administer the loading dose of morphine.

Correct answer: S

Rationale: In this scenario, the best action is to set up the patient-controlled analgesia (PCA) and administer the loading dose of morphine. The patient's pain level is high, which can hinder deep breathing and coughing. Addressing pain control is a priority to facilitate optimal respiratory function. Milking the chest tube to remove clots is unnecessary as the drainage amount is not alarming in the early postoperative period. Clamping the chest tube to locate the air leak is not recommended as it can lead to tension pneumothorax. Assisting the patient to deep breathe, cough, and use the incentive spirometer is important but should follow adequate pain management to ensure the patient can effectively participate in these activities.

4. A patient is being visited at home by a healthcare professional. The patient has been taking Naproxen for back pain. Which statement made by the patient most indicates that the healthcare professional needs to contact the physician?

• A. I get an upset stomach if I don't take Naproxen with my meals.
• B. My back pain right now is about a 3/10.
• C. I get occasional headaches since taking Naproxen
• D. I have ringing in my ears.

Correct answer: D

Rationale: The correct answer is 'I have ringing in my ears.' Ringing in the ears is a severe adverse effect of Naproxen, indicating potential toxicity. This symptom warrants immediate medical attention. Choices A, B, and C are less concerning and do not directly indicate a severe adverse effect or toxicity related to Naproxen. Upset stomach, mild back pain, and occasional headaches are common side effects that may not require immediate physician contact.

5. The mother of a newborn infant with hypospadias asks the nurse why circumcision cannot be performed. Which is the most appropriate response by the nurse?

• A. Circumcision will cause an infection.
• B. Circumcision is not performed in a newborn.
• C. Circumcision will cause difficulty with urination.
• D. Circumcision has been delayed to save tissue for surgical repair.

Correct answer: D

Rationale: The reason circumcision is not performed in a newborn with hypospadias is that the dorsal foreskin tissue will be needed for the surgical repair of hypospadias. Delaying circumcision allows for the preservation of tissue that will be crucial for the corrective surgery. This surgical repair is typically done within the first year of life to minimize the psychological impact on the child. Choices A, B, and C are incorrect as they do not address the specific reason for delaying circumcision in this case.

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