Nursing Elites

1. A nurse is caring for a 2-day-old infant who has a bilirubin level of 19 mg/dl. The physician has ordered phototherapy. Which of the following actions indicates correct preparation of the infant for this procedure?

• A. Undress the baby down to a diaper and hat
• B. Place the baby in his mother's arms before turning on the light
• C. Position the phototherapy light approximately 3 inches above the baby's skin
• D. Secure eye protection for the infant without occluding the nose

Correct answer: D

Rationale: Phototherapy is used to treat high levels of bilirubin among infants, typically evidenced as jaundice. The nurse must position the infant carefully during this procedure to maximize the benefits of the light therapy while protecting the baby. Placing protective eyewear over the baby's eyes without covering the nose is crucial to shield the eyes from the ultraviolet light. Undressing the baby down to a diaper and hat (Choice A) is a standard practice to maximize skin exposure to the phototherapy light. Placing the baby in his mother's arms before turning on the light (Choice B) is not necessary for the preparation of the infant for phototherapy. Positioning the phototherapy light approximately 3 inches above the baby's skin (Choice C) is incorrect as the distance should be as recommended by the healthcare provider based on the manufacturer's instructions.

2. The nurse is writing out discharge instructions for the parents of a child diagnosed with celiac disease. The nurse should focus primarily on which aspect of care?

• A. Restricting activity
• B. Following a gluten-free diet
• C. Following a lactose-free diet
• D. Giving medication to manage the condition

Correct answer: B

Rationale: The primary nursing consideration in the care of a child with celiac disease is to instruct the child and parents about proper dietary management. The cornerstone of managing celiac disease is maintaining a strict gluten-free diet to prevent symptoms and long-term complications. While medications may be part of the treatment plan, dietary adjustments, particularly following a gluten-free diet, are crucial for managing the condition effectively. Restricting activity is not the primary focus of care for celiac disease. A lactose-free diet is not typically necessary unless the child also has lactose intolerance, which is distinct from celiac disease.

3. The patient with idiopathic pulmonary arterial hypertension (IPAH) is receiving epoprostenol (Flolan). Which assessment information requires the most immediate action by the nurse?

• A. The oxygen saturation is 94%.
• B. The blood pressure is 98/56 mm Hg.
• C. The patient's central IV line is disconnected.
• D. The international normalized ratio (INR) is prolonged.

Correct answer: C

Rationale: The most immediate action required by the nurse is to address the disconnected central IV line delivering epoprostenol (Flolan). Epoprostenol has a short half-life of 6 minutes, necessitating immediate reconnection to prevent rapid clinical deterioration. While oxygen saturation, blood pressure, and INR are important parameters requiring monitoring and intervention, the priority lies in ensuring the continuous delivery of the critical medication to stabilize the patient's condition.

4. A female patient with atrial fibrillation has the following lab results: Hemoglobin of 11 g/dl, a platelet count of 150,000, an INR of 2.5, and potassium of 2.7 mEq/L. Which result is critical and should be reported to the physician immediately?

• A. Hemoglobin of 11 g/dl
• B. Platelet count of 150,000
• C. INR of 2.5
• D. Potassium of 2.7 mEq/L

Correct answer: D

Rationale: The critical lab result that should be reported to the physician immediately in this case is the potassium level of 2.7 mEq/L. A potassium imbalance, especially in a patient with a history of dysrhythmia like atrial fibrillation, can be life-threatening and lead to cardiac distress. Low potassium levels (hypokalemia) can predispose the patient to dangerous arrhythmias, including worsening atrial fibrillation. Hemoglobin of 11 g/dl, platelet count of 150,000, and an INR of 2.5 are within acceptable ranges and not as immediately concerning as a low potassium level in this clinical context.

5. A patient has been taking mood stabilizing medication but is afraid of needles. They ask the nurse what medication would NOT require regular lab testing. What is the nurse's best response?

• A. Valproic Acid (Depakote)
• B. Clozapine (Clozaril)
• C. Lithium
• D. Risperidone (Risperdal)

Correct answer: D

Rationale: The correct answer is Risperidone (Risperdal) because it is the only medication among the options that does not require regular lab testing. Risperidone is not associated with the need for routine blood draws to monitor medication levels or potential side effects. Choices A, B, and C (Valproic Acid, Clozapine, Lithium) are all known to require frequent lab monitoring due to various reasons such as potential toxicity, therapeutic drug levels, or adverse effects on certain organ functions. Therefore, considering the patient's fear of needles and the desire to avoid frequent blood tests, Risperidone would be the most suitable option.

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