Nursing Elites

1. A patient is being discharged after an emergency splenectomy following a motor vehicle crash. Which instructions should the nurse include in the discharge teaching?

• A. Check frequently for swollen lymph nodes.
• B. Watch for excessive bleeding or bruising.
• C. Take iron supplements to prevent anemia.
• D. Wash hands and avoid individuals who are ill.

Correct answer: D

Rationale: The correct answer is D. After a splenectomy, the patient is at an increased risk of infection, particularly from gram-positive bacteria. Washing hands and avoiding contact with individuals who are ill are crucial to reduce this risk. Choice A is incorrect because checking for swollen lymph nodes is not a priority after a splenectomy. Choice B is incorrect as while bleeding is a concern, it is more immediate post-operatively. Choice C is incorrect as iron supplements do not specifically relate to the risk of infection post-splenectomy.

2. Which task for a patient with neutropenia is appropriate for the registered nurse (RN) to delegate to a licensed practical/vocational nurse (LPN/LVN)?

• A. Assessing the patient for signs and symptoms of infection
• B. Teaching the patient the purpose of neutropenic precautions
• C. Administering subcutaneous filgrastim (Neupogen) injection
• D. Developing a discharge teaching plan for the patient and family

Correct answer: C

Rationale: The correct answer is C because administering subcutaneous medications falls within the education and scope of practice of an LPN/LVN. Assessing the patient for signs and symptoms of infection, teaching the patient, and developing a discharge plan are tasks that require an RN level of education and scope of practice. LPN/LVNs can assist in patient care, but tasks that involve assessment, teaching, and care planning are typically the responsibility of an RN.

3. During a physical assessment, the nurse examines the lymph nodes of a patient. Which assessment finding would be of most concern to the nurse?

• A. A 2-cm nontender supraclavicular node
• B. A 1-cm mobile and nontender axillary node
• C. An inability to palpate any superficial lymph nodes
• D. Firm inguinal nodes in a patient with an infected foot

Correct answer: A

Rationale: The correct answer is A. A 2-cm nontender supraclavicular node is of most concern because enlarged and nontender nodes in this area are highly suggestive of malignancies such as lymphoma. Choice B is less concerning as a 1-cm mobile and nontender axillary node is usually benign. Choice C, an inability to palpate any superficial lymph nodes, could be due to factors like obesity or edema, but it is not necessarily a cause for immediate concern. Choice D, firm inguinal nodes in a patient with an infected foot, may indicate a local reaction to infection rather than a systemic issue related to malignancy.

4. A 62-year-old man with chronic anemia is experiencing increased fatigue and occasional palpitations at rest. The nurse would expect the patient's laboratory test findings to include

• A. an RBC count of 4,500,000/μL.
• B. a hematocrit (Hct) value of 38%.
• C. normal red blood cell (RBC) indices.
• D. a hemoglobin (Hgb) of 8.6 g/dL.

Correct answer: B

Rationale: The correct answer is B. In chronic anemia, the hematocrit (Hct) value is a crucial indicator of the proportion of red blood cells in the blood. A hematocrit value of 38% indicates a lower than normal level of red blood cells, which aligns with the patient's symptoms of fatigue and palpitations. Choices A, C, and D are incorrect because a low RBC count, normal RBC indices, and a hemoglobin level of 8.6 g/dL do not specifically address the decreased red blood cell mass associated with chronic anemia.

5. The health care provider orders a liver and spleen scan for a patient who has been in a motor vehicle crash. Which action should the nurse take before this procedure?

• A. Check for any iodine allergy.
• B. Insert a large-bore IV catheter.
• C. Administer prescribed sedatives.
• D. Assist the patient to a flat position.

Correct answer: D

Rationale: Before a liver and spleen scan, it is essential to assist the patient to a flat position. This position helps obtain clear images of the liver and spleen. Checking for iodine allergy (Choice A) is more relevant for procedures involving contrast dye, not a liver and spleen scan. Inserting a large-bore IV catheter (Choice B) may not be necessary for this specific procedure. Administering sedatives (Choice C) is not typically required for a liver and spleen scan, as the patient needs to remain still during the procedure.

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