Nursing Elites

1. A 52-year-old patient has a new diagnosis of pernicious anemia. The nurse determines that the patient understands the teaching about the disorder when the patient states:

• A. I need to start eating more red meat and liver.
• B. I will stop having a glass of wine with dinner.
• C. I could choose nasal spray rather than injections of vitamin B12.
• D. I will need to take a proton pump inhibitor such as omeprazole (Prilosec).

Correct answer: C

Rationale: The correct answer is C. Pernicious anemia is a condition where the body can't absorb enough vitamin B12. Treatment usually involves lifelong replacement of vitamin B12. In this case, the patient understanding the disorder is correctly demonstrated by choosing nasal spray or injections of vitamin B12 for replacement therapy. Choices A, B, and D are incorrect because increasing red meat/liver intake, stopping wine consumption, or taking a proton pump inhibitor like omeprazole do not address the primary issue of vitamin B12 absorption in pernicious anemia.

2. A patient is considering options to manage his/her coronary artery disease. The nurse explains a coronary artery bypass graft procedure will:

• A. Cure the patient's coronary artery disease.
• B. Replace the leaking valve in the heart.
• C. Connect grafts to aorta to improve blood flow.
• D. Place a permanent pacemaker on the heart muscle.

Correct answer: C

Rationale: The correct answer is C. A coronary artery bypass graft procedure involves connecting grafts to the aorta to improve blood flow to the heart muscle by bypassing blocked or narrowed coronary arteries. This procedure does not cure coronary artery disease but helps improve blood supply to the heart. Choices A, B, and D are incorrect because a bypass graft procedure does not cure the underlying disease, replace heart valves, or involve the placement of a pacemaker.

3. When providing care for a patient with sickle cell crisis, what is important for the nurse to do?

• A. Monitor the patient's intake of oral and IV fluids
• B. Evaluate the effectiveness of opioid analgesics
• C. Encourage the patient to ambulate as much as tolerated
• D. Educate the patient about high-protein, high-calorie foods

Correct answer: B

Rationale: The correct answer is to evaluate the effectiveness of opioid analgesics. In sickle cell crisis, pain is the most common symptom and is usually managed with large doses of continuous opioids. Monitoring fluid intake (Choice A) is important, but limiting fluids may not be necessary. Encouraging ambulation (Choice C) is generally good but may not be the priority during a sickle cell crisis. Educating the patient about nutrition (Choice D) is important for overall health but may not be the immediate focus during a crisis.

4. An appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia is to

• A. provide a diet high in vitamin K
• B. alternate periods of rest and activity
• C. teach the patient how to avoid injury
• D. place the patient on protective isolation

Correct answer: B

Rationale: In severe hemolytic anemia, the priority nursing intervention is to alternate periods of rest and activity. This approach helps to balance activity levels to prevent excessive fatigue while promoting mobility and preventing complications such as muscle weakness or deconditioning. Providing a diet high in vitamin K (choice A) is not directly related to managing hemolytic anemia. Teaching the patient how to avoid injury (choice C) is important but may not be the immediate priority. Placing the patient on protective isolation (choice D) is not indicated for hemolytic anemia, as it is not a contagious condition.

5. The nurse notes scleral jaundice in a patient being admitted with hemolytic anemia. The nurse will plan to check the laboratory results for the

• A. Schilling test
• B. bilirubin level
• C. gastric analysis
• D. stool occult blood

Correct answer: B

Rationale: The correct answer is B: bilirubin level. Jaundice, characterized by scleral jaundice, is caused by the elevation of bilirubin levels associated with red blood cell hemolysis. Checking the bilirubin level in the laboratory results will help assess the severity of jaundice in the patient. Choices A, C, and D are incorrect because the Schilling test is used to assess vitamin B12 absorption, gastric analysis is used to evaluate gastric function, and stool occult blood is used to detect hidden blood in the stool, which are not directly related to evaluating jaundice in a patient with hemolytic anemia.

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