Nursing Elites

1. A diabetic patient's arterial blood gas (ABG) results are pH 7.28; PaCO2 34 mm Hg; PaO2 85 mm Hg; HCO3 18 mEq/L. The nurse would expect which finding?

• A. Intercostal retractions
• B. Kussmaul respirations
• C. Low oxygen saturation (SpO2)
• D. Decreased venous O2 pressure

Correct answer: Kussmaul respirations

Rationale: Kussmaul respirations (deep and rapid) are a compensatory mechanism for metabolic acidosis. The low pH and low bicarbonate levels indicate metabolic acidosis. Intercostal retractions, low oxygen saturation, and decreased venous O2 pressure are not associated with acidosis. Intercostal retractions typically occur in respiratory distress, while low oxygen saturation and decreased venous O2 pressure are more related to respiratory or circulatory issues, not metabolic acidosis.

2. A patient who has a history of chronic obstructive pulmonary disease (COPD) was hospitalized for increasing shortness of breath and chronic hypoxemia (SaO2 levels of 89% to 90%). In planning for discharge, which action by the nurse will be most effective in improving compliance with discharge teaching?

• A. Start giving the patient discharge teaching on the day of discharge
• B. Have the patient repeat the instructions immediately after teaching
• C. Accomplish the patient teaching just before the scheduled discharge
• D. Arrange for the patient's caregiver to be present during the teaching

Correct answer: Arrange for the patient's caregiver to be present during the teaching

Rationale: Hypoxemia interferes with the patient's ability to learn and retain information, so having the patient's caregiver present will increase the likelihood that discharge instructions will be followed. Having the patient repeat the instructions will indicate that the information is understood at the time, but it does not guarantee retention of the information. Giving discharge instructions just before discharge is not ideal as the patient is likely to be distracted and anxious at that time. Teaching the patient about discharge on the day of admission is not recommended because the patient may be more hypoxemic and anxious than usual, making it difficult for them to absorb and retain the information effectively. Therefore, arranging for the patient's caregiver to be present during the teaching session is the best option to ensure proper compliance and understanding of the discharge instructions.

3. When reading a lab report, you notice that a patient's sample is described as having anisocytosis. Which of the following most accurately describes the patient's condition?

• A. The patient has an abnormal condition of skin cells.
• B. The patient's red blood cells vary in size.
• C. The patient has a high level of fat cells and is obese.
• D. The patient's cells are indicative of necrosis.

Correct answer: The patient's red blood cells vary in size.

Rationale: Anisocytosis is a term that indicates variation in the size of red blood cells. When a patient is described as having anisocytosis, it means their red blood cells exhibit differences in size. This condition can be detected in blood samples and may indicate underlying blood disorders. The other choices are incorrect: Choice A refers to a skin cell condition, Choice C relates to obesity and fat cells, and Choice D suggests necrosis, none of which are associated with anisocytosis or red blood cell abnormalities. It is important to recognize specific terms like anisocytosis in laboratory reports to understand the potential implications for the patient's health.

4. During shift change, a healthcare professional is reviewing a patient's medication. Which of the following medications would be contraindicated if the patient were pregnant?

• A. Warfarin (Coumadin)
• B. Celecoxib (Celebrex)
• C. Clonidine (Catapres)
• D. Transdermal nicotine (Habitrol)

Correct answer: Warfarin (Coumadin)

Rationale: Warfarin (Coumadin) is contraindicated in pregnancy due to its pregnancy category X classification. It is associated with central nervous system defects, spontaneous abortion, stillbirth, prematurity, hemorrhage, and ocular defects when administered at any time during pregnancy. Fetal warfarin syndrome can occur when given during the first trimester. Celecoxib (Celebrex) is a pregnancy category C medication, which means there may be risks but benefits may outweigh them. Clonidine (Catapres) is also a pregnancy category C drug, and while animal studies have shown adverse effects on the fetus, there are limited human studies. Transdermal nicotine (Habitrol) is classified as a pregnancy category D drug, indicating positive evidence of fetal risk, but benefits may still warrant its use in pregnant women with serious conditions.

5. A 3-year-old had a hip spica cast applied 2 hours ago. In order to facilitate drying, the nurse should

• A. Expose the cast to air and turn the child frequently
• B. Use a heat lamp to reduce the drying time
• C. Handle the cast with the abductor bar
• D. Turn the child as little as possible

Correct answer: Expose the cast to air and turn the child frequently

Rationale: After applying a hip spica cast, it is important to facilitate drying by exposing the cast to air and turning the child frequently. This helps promote even drying and prevents complications such as skin breakdown. Using a heat lamp can cause burns and is not recommended. Handling the cast with the abductor bar does not aid in drying the cast. Turning the child as little as possible is incorrect as regular turning is crucial to prevent complications.

Similar Questions