Nursing Elites

1. A patient is on bedrest 24 hours after a hip fracture. Which regular assessment or intervention is essential for detecting or preventing the complication of Fat Embolism Syndrome?

• A. Performing passive, light range-of-motion exercises on the hip as tolerated.
• B. Assess the patient's mental status for drowsiness or sleepiness.
• C. Assess the pedal pulse and capillary refill in the toes.
• D. Administer a stool softener as ordered.

Correct answer: B

Rationale: In detecting or preventing Fat Embolism Syndrome (FES), assessing the patient's mental status for drowsiness or sleepiness is crucial. Decreased level of consciousness is an early sign of FES due to decreased oxygen levels. Performing passive, light range-of-motion exercises on the hip may not directly relate to FES. Assessing pedal pulse and capillary refill in the toes is essential for assessing circulation but not specific to detecting FES. Administering a stool softener, while important for preventing constipation in immobilized patients, is not directly related to detecting or preventing FES.

2. The nurse is caring for a 13-year-old following spinal fusion for scoliosis. Which of the following interventions is appropriate in the immediate post-operative period?

• A. Raise the head of the bed at least 30 degrees
• B. Encourage ambulation within 24 hours
• C. Maintain in a flat position, logrolling as needed
• D. Encourage leg contraction and relaxation after 48 hours

Correct answer: C

Rationale: In the immediate post-operative period following spinal fusion for scoliosis in a 13-year-old, it is important to maintain the patient in a flat position and perform logrolling as needed. This helps prevent injury to the surgical site and ensures proper spinal alignment. Raising the head of the bed at least 30 degrees is contraindicated as it can put strain on the surgical site. Encouraging ambulation within 24 hours may be appropriate in the recovery process but not in the immediate post-operative period. Encouraging leg contraction and relaxation after 48 hours may also be part of the rehabilitation process but is not a priority in the immediate post-operative period.

3. A patient with a possible pulmonary embolism complains of chest pain and difficulty breathing. The nurse finds a heart rate of 142 beats/minute, blood pressure of 100/60 mmHg, and respirations of 42 breaths/minute. Which action should the nurse take first?

• A. Administer anticoagulant drug therapy.
• B. Notify the patient's healthcare provider.
• C. Prepare the patient for a spiral computed tomography (CT).
• D. Elevate the head of the bed to a semi-Fowler's position.

Correct answer: D

Rationale: The patient presents with symptoms indicative of a pulmonary embolism (PE), such as chest pain, difficulty breathing, tachycardia, hypotension, and tachypnea. Elevating the head of the bed to a semi-Fowler's position is the priority to improve ventilation and gas exchange. This intervention should be initiated promptly to optimize oxygenation. Subsequent actions, such as notifying the healthcare provider, preparing for a spiral CT scan, and administering anticoagulant therapy, can follow after the patient's position is adjusted. The spiral CT scan is typically used to confirm the diagnosis of PE, and anticoagulant therapy is initiated upon confirmation of the diagnosis by the healthcare provider. Therefore, the immediate focus is on improving the patient's respiratory status by elevating the head of the bed.

4. A nurse admits a 3-week-old infant to the special care nursery with a diagnosis of bronchopulmonary dysplasia. As the nurse reviews the birth history, which data would be most consistent with this diagnosis?

• A. Gestational age assessment suggested growth retardation
• B. Meconium was cleared from the airway at delivery
• C. Phototherapy was used to treat Rh incompatibility
• D. The infant received mechanical ventilation for 2 weeks

Correct answer: D

Rationale: The correct answer is 'The infant received mechanical ventilation for 2 weeks.' Bronchopulmonary dysplasia is a condition primarily caused by therapies like positive-pressure ventilation used in the treatment of lung disease. This leads to lung damage and subsequent respiratory problems. Choices A, B, and C are not consistent with the diagnosis of bronchopulmonary dysplasia. Gestational age assessment suggesting growth retardation is more indicative of intrauterine growth restriction, clearing meconium from the airway at delivery is related to potential respiratory issues at birth, and phototherapy for Rh incompatibility is unrelated to bronchopulmonary dysplasia.

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: A

Rationale: After a hip spica cast is applied, it is important to facilitate drying by exposing the cast to air and turning the child frequently, approximately every 2 hours. This helps ensure even drying and prevents skin breakdown. Using a heat lamp can cause burns and should be avoided. Handling the cast with the abductor bar is not necessary for the drying process and may cause discomfort to the child. Turning the child as little as possible is not recommended as regular turning helps prevent complications like pressure ulcers and stiffness.

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