Nursing Elites

1. A client is 36 hours post-op a TKR surgery. 270 cc of sero-sanguinous fluid accumulates in the surgical drains. What action should the nurse take?

• A. Notify the doctor
• B. Empty the drain
• C. Do nothing
• D. Remove the drain

Correct answer: A

Rationale: The correct action for the nurse to take in this situation is to notify the doctor. Significant sero-sanguinous drainage after TKR surgery could indicate a potential issue such as infection or bleeding. The physician needs to be informed promptly to assess the situation and determine the appropriate course of action. Emptying the drain, doing nothing, or removing the drain without consulting the physician could lead to complications going unnoticed or untreated. It is crucial to involve the physician in decision-making to ensure the best outcomes for the client.

2. What type of diet is appropriate for a client with chronic cirrhosis?

• A. High calorie, low protein
• B. High protein, high calorie
• C. Low fat, low sodium
• D. High calorie, low sodium

Correct answer: A

Rationale: The correct diet for a client with chronic cirrhosis is high calorie, low protein. Cirrhosis can lead to impaired protein metabolism, making it essential to limit protein intake. High-calorie foods help meet the client's energy needs. Choice B (High protein, high calorie) is incorrect because high protein intake can worsen hepatic encephalopathy. Choice C (Low fat, low sodium) is not the most appropriate diet for cirrhosis as the focus should be on calories and protein. Choice D (High calorie, low sodium) does not address the need to restrict protein intake, which is crucial in cirrhosis.

3. In alcoholics with anemia:

• A. Pernicious anemia is more common than folic acid deficiency.
• B. Iron deficiency and folic acid deficiency can coexist.
• C. The alcohol interferes with iron absorption.
• D. Oral vitamin replacement is contraindicated.

Correct answer: B

Rationale: In alcoholics with anemia, iron deficiency and folic acid deficiency can coexist due to poor dietary intake and malabsorption issues associated with chronic alcohol consumption. Pernicious anemia, primarily related to vitamin B12 deficiency, is not commonly seen in alcoholics. While alcohol can interfere with iron absorption, it is not the sole factor contributing to anemia in alcoholics. Oral vitamin replacement is not contraindicated in alcoholics with anemia; however, it may be less effective due to absorption issues related to alcohol consumption.

4. A one-month-old infant in the neonatal intensive care unit is dying. The parents request that the nurse administer an opioid analgesic to their infant, who is crying weakly. The infant's heart rate is 68 beats per minute, and the respiratory rate is 18 breaths per minute. The infant is on room air, and the oxygen saturation is 92%. The nurse's response is based on which of the following principles?

• A. Providing analgesia during the last days and hours is an ethically appropriate nursing action.
• B. Withholding the opioid analgesia during the last days and hours is an ethical duty because administering it would represent assisted suicide.
• C. Administering analgesia during the last days and hours is the parents' ethical decision.
• D. Withholding the opioid analgesia is clinically appropriate because it will hasten the infant's death.

Correct answer: A

Rationale: All patients, regardless of age, have the right to die with dignity and be free from pain. In this case, the parents' request for an opioid analgesic to relieve the child's distress aligns with the principles of palliative care and ensuring comfort. Assisted suicide involves a conscious decision by the individual, which is not applicable to a 1-month-old infant. Both the nurse and the parents have an ethical duty to ensure the infant's comfort and well-being. Withholding opioid analgesia solely to hasten death is not appropriate, as providing pain relief is a crucial aspect of end-of-life care. Opioids can be administered to dying patients at any age to alleviate suffering without the intention of hastening death. Therefore, providing analgesia during the last days and hours is an ethically appropriate nursing action. Choices B, C, and D are incorrect because the decision to administer analgesia in this scenario is based on the best interest and comfort of the infant, not concerns about assisted suicide or hastening death. The ethical consideration is to provide compassionate care and alleviate suffering.

5. Which of the following nursing diagnoses is most appropriate for the client experiencing acute pancreatitis?

• A. Confusion
• B. Latex Allergy
• C. Acute Pain
• D. Constipation

Correct answer: C

Rationale: Acute Pain is the most appropriate nursing diagnosis for a client experiencing acute pancreatitis because it is a common symptom associated with this condition. Pancreatitis often presents with severe abdominal pain that may radiate to the back. Confusion, Latex Allergy, and Constipation are not typically associated with acute pancreatitis. Confusion may occur in severe cases of pancreatitis with complications, but acute pain is the priority nursing diagnosis due to its prevalence and impact on the client's well-being.

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