Nursing Elites

1. A nurse is caring for a patient after a coronary angiogram. Which of these actions taken by the nursing assistant would most require the nurse's immediate intervention?

• A. The nursing assistant fills the patient's pitcher with ice-cold drinking water
• B. The nursing assistant elevates the head of the bed to 60 degrees for a meal
• C. The nursing assistant refills the ice pack placed on the insertion site
• D. The nursing assistant places an extra pillow under the patient's head upon request

Correct answer: B

Rationale: After a coronary angiogram, patients need to maintain bed rest and keep the head of the bed at no more than 30 degrees for 3-6 hours, depending on the insertion site. Elevating the head of the bed to 60 degrees for a meal could increase the risk of bleeding or complications at the insertion site. Refilling the ice pack placed on the insertion site is appropriate for managing potential swelling or discomfort. Filling the patient's pitcher with ice-cold drinking water is a standard care task. Placing an extra pillow under the patient's head upon request is a comfort measure and does not pose a risk to the patient's recovery.

2. What is the most frequent cause for suicide in adolescents?

• A. Progressive failure to adapt
• B. Feelings of anger or hostility
• C. Reunion wish or fantasy
• D. Feelings of alienation or isolation

Correct answer: D

Rationale: Feelings of alienation or isolation are the most frequent cause for suicide in adolescents. Adolescents may experience a gradual isolation leading to a loss of meaningful social contacts, which can be self-imposed or result from an inability to express feelings. During this developmental stage, achieving a sense of identity and peer acceptance is crucial. Choices A, B, and C are incorrect: Progressive failure to adapt, feelings of anger or hostility, and reunion wish or fantasy are not typically identified as the primary cause of suicide in adolescents.

3. When taking a patient’s history, she mentions being depressed and dealing with an anxiety disorder. Which of the following medications would the patient most likely be taking?

• A. Amitriptyline (Elavil)
• B. Calcitonin
• C. Pergolide mesylate (Permax)
• D. Verapamil (Calan)

Correct answer: A

Rationale: The correct answer is Amitriptyline (Elavil) as it is a tricyclic antidepressant commonly used to treat symptoms of depression and anxiety disorders. Amitriptyline works by increasing the levels of certain neurotransmitters in the brain to improve mood. Choices B, C, and D are incorrect. Calcitonin is a hormone used in the treatment of osteoporosis; Pergolide mesylate is a dopamine agonist used in Parkinson's disease; Verapamil is a calcium channel blocker used to treat high blood pressure and certain heart conditions, not mental health disorders.

4. The nurse is reviewing the lab results of a patient taking lithium for schizoaffective disorder. The lab results show that the blood lithium value is 1.7 mcg/L. What would the nurse take as the priority action?

• A. Induce vomiting
• B. Hold the next dose of Lithium
• C. Administer an antiemetic
• D. Give the next dose of Lithium

Correct answer: B

Rationale: The correct answer is to hold the next dose of Lithium. The blood lithium value of 1.7 mcg/L exceeds the therapeutic range of 0.5-1.5 mcg/L, indicating potential toxicity. Holding the next dose is crucial to prevent further accumulation of lithium in the bloodstream. Inducing vomiting is not appropriate in this situation as the priority is to prevent further absorption of lithium. Administering an antiemetic is not the priority in lithium toxicity. Giving the next dose of lithium would exacerbate the toxicity and should be avoided.

5. A patient is admitted to the same-day surgery unit for a liver biopsy. Which of the following laboratory tests assesses coagulation? Select one that doesn't apply.

• A. Partial thromboplastin time
• B. Prothrombin time
• C. Platelet count
• D. Hemoglobin

Correct answer: D

Rationale: The correct answer is 'Hemoglobin.' Hemoglobin levels are not indicative of coagulation status but are important for assessing oxygen-carrying capacity. Choices A, B, and C are all laboratory tests that assess coagulation. Partial thromboplastin time (PTT) and prothrombin time (PT) evaluate different aspects of the coagulation cascade, while platelet count is essential for assessing primary hemostasis. Therefore, in the context of evaluating coagulation, hemoglobin is not the appropriate choice.

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