Nursing Elites

1. A 44-year-old with sickle cell anemia who says his eyes always look sort of yellow

• A. A 23-year-old with no previous health problems who has a nontender lump in the axilla
• B. A 50-year-old with early-stage chronic lymphocytic leukemia who reports chronic fatigue
• C. A 19-year-old with hemophilia who wants to learn to self-administer factor VII replacement
• D. A 44-year-old with sickle cell anemia who says his eyes always look sort of yellow

Correct answer: B

Rationale: Choice B is the correct answer because the scenario describes a 50-year-old with early-stage chronic lymphocytic leukemia who presents with chronic fatigue. Chronic lymphocytic leukemia commonly presents with symptoms like fatigue, weight loss, and enlarged lymph nodes. The other choices are less likely as they do not match the clinical presentation described in the scenario. Choice A describes a 23-year-old with a nontender lump in the axilla, which is more suggestive of a benign condition like a lipoma. Choice C describes a 19-year-old with hemophilia who wants to learn to self-administer factor VII replacement, which is unrelated to the symptoms of chronic lymphocytic leukemia. Choice D repeats the scenario, which is not relevant in selecting the appropriate answer.

2. Which instruction will the nurse plan to include in discharge teaching for a patient admitted with a sickle cell crisis?

• A. Take a daily multivitamin with iron
• B. Limit fluids to 2 to 3 quarts per day
• C. Avoid exposure to crowds when possible
• D. Drink only two caffeinated beverages daily

Correct answer: C

Rationale: The correct answer is C: 'Avoid exposure to crowds when possible.' This instruction is crucial in discharge teaching for a patient admitted with a sickle cell crisis because exposure to crowds increases the risk of infection, which is the most common cause of sickle cell crisis. Choices A, B, and D are incorrect. Taking a daily multivitamin with iron (Choice A) may be beneficial for some individuals but is not specifically related to managing sickle cell crisis. Limiting fluids to 2 to 3 quarts per day (Choice B) is not typically recommended for patients with sickle cell crisis, as adequate hydration is important. Drinking only two caffeinated beverages daily (Choice D) is not a priority instruction in managing sickle cell crisis.

3. A patient is being discharged after an emergency splenectomy following a motor vehicle crash. Which instructions should the nurse include in the discharge teaching?

• A. Check frequently for swollen lymph nodes.
• B. Watch for excessive bleeding or bruising.
• C. Take iron supplements to prevent anemia.
• D. Wash hands and avoid individuals who are ill.

Correct answer: D

Rationale: The correct answer is D. After a splenectomy, the patient is at an increased risk of infection, particularly from gram-positive bacteria. Washing hands and avoiding contact with individuals who are ill are crucial to reduce this risk. Choice A is incorrect because checking for swollen lymph nodes is not a priority after a splenectomy. Choice B is incorrect as while bleeding is a concern, it is more immediate post-operatively. Choice C is incorrect as iron supplements do not specifically relate to the risk of infection post-splenectomy.

4. A patient's complete blood count (CBC) shows a hemoglobin of 19 g/dL and a hematocrit of 54%. Which question should the nurse ask to determine possible causes of this finding?

• A. Have you had any recent weight loss?
• B. Do you have any history of lung disease?
• C. Have you noticed any dark or bloody stools?
• D. What is your dietary intake of meats and proteins?

Correct answer: B

Rationale: The correct answer is B: "Do you have any history of lung disease?" The elevated hemoglobin and hematocrit levels suggest polycythemia, which can be seen in conditions like chronic obstructive pulmonary disease (COPD). Option A is less relevant as weight loss is not typically associated with these blood count findings. Option C is more indicative of gastrointestinal bleeding rather than a respiratory issue. Option D focuses on dietary factors, which are less likely to cause such significant elevations in hemoglobin and hematocrit levels as seen in this case.

5. The health care provider orders a liver and spleen scan for a patient who has been in a motor vehicle crash. Which action should the nurse take before this procedure?

• A. Check for any iodine allergy.
• B. Insert a large-bore IV catheter.
• C. Administer prescribed sedatives.
• D. Assist the patient to a flat position.

Correct answer: D

Rationale: Before a liver and spleen scan, it is essential to assist the patient to a flat position. This position helps obtain clear images of the liver and spleen. Checking for iodine allergy (Choice A) is more relevant for procedures involving contrast dye, not a liver and spleen scan. Inserting a large-bore IV catheter (Choice B) may not be necessary for this specific procedure. Administering sedatives (Choice C) is not typically required for a liver and spleen scan, as the patient needs to remain still during the procedure.

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