Nursing Elites

1. A patient has acute bronchitis with a nonproductive cough and wheezes. Which topic should the nurse plan to include in the teaching plan?

• A. Purpose of antibiotic therapy
• B. Ways to limit oral fluid intake
• C. Appropriate use of cough suppressants
• D. Safety concerns with home oxygen therapy

Correct answer: C

Rationale: In acute bronchitis, which is often viral, cough suppressants can help manage the symptoms of a nonproductive cough. Antibiotics are not typically used in acute bronchitis unless there are systemic symptoms indicating a bacterial infection. Limiting oral fluid intake is not recommended; in fact, maintaining adequate hydration is important. Safety concerns with home oxygen therapy may not be directly relevant to the management of acute bronchitis.

2. 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: B

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.

3. A patient with leukemia is receiving chemotherapy that is known to depress bone marrow. A CBC (complete blood count) reveals a platelet count of 25,000/microliter. Which of the following actions related specifically to the platelet count should be included in the nursing care plan?

• A. Monitor for fever every 4 hours.
• B. Require visitors to wear respiratory masks and protective clothing.
• C. Consider transfusion of packed red blood cells.
• D. Check for signs of bleeding, including examination of urine and stool for blood.

Correct answer: D

Rationale: A platelet count of 25,000/microliter indicates severe thrombocytopenia, which increases the risk of bleeding. It is crucial to initiate bleeding precautions, including regularly checking for signs of bleeding such as examining urine and stool for blood. Monitoring for fever every 4 hours (Choice A) should be included for neutropenic precautions, not specifically related to platelet count. Requiring visitors to wear respiratory masks and protective clothing (Choice B) is more relevant for patients with airborne precautions. Considering transfusion of packed red blood cells (Choice C) is not indicated for low platelet count but is more appropriate for managing anemia or low hemoglobin levels.

4. Which of the following interventions should the nurse use when working with a Jackson-Pratt drain?

• A. Strip the tubing to remove clots by milking the tubing back toward the client
• B. Empty the drain when the amount of fluid reaches 25 cc
• C. Strip the tubing to remove clots by milking the tubing away from the client
• D. Maintain the level of the drain above the client's incision

Correct answer: C

Rationale: A Jackson-Pratt drain is a type of active wound drain that may be placed following a surgical procedure. This drain actively draws excess blood and fluid out of the wound. If clots develop within the tubing, the nurse should strip the tubing by milking it in a direction away from the client. This action helps to ensure the drain remains patent and effective. Option A is incorrect because the tubing should be milked away from the client, not towards. Option B is incorrect as the drain should be emptied based on the healthcare provider's orders, not at a fixed volume. Option D is incorrect because the level of the drain should be below the level of the incision to allow drainage by gravity.

5. Septic, anaphylactic, and neurogenic shock are all categorized as:

• A. Hypovolemic shock
• B. Cardiogenic shock
• C. Distributive shock
• D. Obstructive shock

Correct answer: C

Rationale: Septic, anaphylactic, and neurogenic shock are all types of distributive shock. Distributive shock is characterized by a decrease in systemic vascular resistance, leading to poor tissue perfusion. Septic shock is caused by severe infection, anaphylactic shock is an extreme allergic reaction, and neurogenic shock results from damage to the nervous system. Hypovolemic shock (Choice A) is characterized by a decrease in intravascular volume, cardiogenic shock (Choice B) is due to heart failure, and obstructive shock (Choice D) results from obstruction of blood flow. Therefore, the correct categorization for septic, anaphylactic, and neurogenic shock is distributive shock.

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