Nursing Elites

1. A child is diagnosed with acquired aplastic anemia. The nurse knows that this child has the best prognosis with which treatment regimen?

• A. blood transfusion
• B. chemotherapy
• C. bone marrow transplantation
• D. immunosuppressive therapy

Correct answer: C

Rationale: In the case of acquired aplastic anemia, bone marrow transplantation offers the best chance of cure as it replaces the abnormal stem cells with healthy ones. Blood transfusion may provide temporary relief by replacing blood cells, but it does not address the root cause of the condition. Chemotherapy may be used in some cases, but it is not the preferred treatment for acquired aplastic anemia. While immunosuppressive therapy can be effective, especially in patients who are not candidates for a bone marrow transplant, it is not the first-line treatment and does not offer the same potential for a cure as bone marrow transplantation.

2. The nurse in the emergency department observes a colleague viewing the electronic health record (EHR) of a client who holds an elected position in the community. The client is not a part of the colleague's assignment. Which action should the nurse implement?

• A. Communicate the colleague's actions to the unit charge nurse
• B. Send an email to facility administration reporting the action
• C. Write an anonymous complaint to a professional website
• D. Post a comment about the action on a staff discussion board

Correct answer: A

Rationale: Viewing the EHR of a client who is not under your care is a violation of HIPAA regulations, regardless of the client's social status or your curiosity. The appropriate action to take in this situation is to communicate the colleague's actions to the unit charge nurse. The charge nurse can then escalate the issue through the appropriate channels within the organization. Reporting to the charge nurse ensures that the incident is handled internally and in accordance with organizational policies and procedures. Sending an email to facility administration, writing an anonymous complaint to a professional website, or posting a comment on a staff discussion board are not the recommended actions as they may not address the issue effectively and could potentially violate confidentiality further.

3. What is the first action the nurse should take when a patient complains of acute chest pain and dyspnea soon after insertion of a centrally inserted IV catheter?

• A. Notify the health care provider.
• B. Offer reassurance to the patient.
• C. Auscultate the patient’s breath sounds
• D. Give the prescribed PRN morphine sulfate IV

Correct answer: C

Rationale: The correct first action for the nurse to take when a patient complains of acute chest pain and dyspnea after the insertion of a centrally inserted IV catheter is to auscultate the patient's breath sounds. This is important to assess for any potential complications such as embolism or pneumothorax, which can present with such symptoms. Auscultation can provide immediate information on the patient's respiratory status and guide further interventions. Notifying the health care provider, offering reassurance, or administering morphine should only be considered after assessing the patient's condition through auscultation.

4. When caring for a patient with renal failure on a low phosphate diet, the nurse will inform unlicensed assistive personnel (UAP) to remove which food from the patient’s food tray?

• A. Grape juice
• B. Milk carton
• C. Mixed green salad
• D. Fried chicken breast

Correct answer: B

Rationale: The correct answer is B: Milk carton. Foods high in phosphate, like milk and other dairy products, are restricted on low-phosphate diets to manage renal failure. Green, leafy vegetables, high-fat foods, and fruits/juices are not high in phosphate and are not restricted. Therefore, grape juice, mixed green salad, and fried chicken breast do not need to be removed from the patient's food tray.

5. A patient who has been receiving diuretic therapy is admitted to the emergency department with a serum potassium level of 3.0 mEq/L. The nurse should alert the healthcare provider immediately that the patient is on which medication?

• A. Oral digoxin (Lanoxin) 0.25 mg daily
• B. Ibuprofen (Motrin) 400 mg every 6 hours
• C. Metoprolol (Lopressor) 12.5 mg orally daily
• D. Lantus insulin 24 U subcutaneously every evening

Correct answer: A

Rationale: The correct answer is A. Hypokalemia increases the risk for digoxin toxicity, which can lead to serious dysrhythmias. Therefore, with a low potassium level, the nurse should immediately alert the healthcare provider about the patient being on oral digoxin. Choices B, C, and D do not pose as much concern with the given potassium level. However, further assessment is still required for these medications.

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