Nursing Elites

1. 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.

2. A client in the ICU has been intubated and placed on a ventilator. The physician orders synchronous intermittent mandatory ventilation (SIMV). Which statement best describes the work of this mode of ventilation?

• A. The ventilator delivers a set rate and tidal volume regardless of whether the client is attempting to breathe
• B. The ventilator coordinates delivered breaths with the client's respiratory efforts
• C. The ventilator provides a supplemental breath for every third breath of the client
• D. The ventilator provides breaths during the expiratory phase of the client's respirations

Correct answer: B

Rationale: Synchronous intermittent mandatory ventilation (SIMV) is a ventilation mode that coordinates delivered breaths with the client's own respiratory efforts. This mode allows the client to initiate breaths, with the ventilator providing preset breaths at a controlled rate and volume. Option A is incorrect because in SIMV, the ventilator syncs with the client's respiratory efforts. Option C is incorrect as it does not accurately depict the way SIMV works. Option D is also incorrect as SIMV does not specifically provide breaths during the expiratory phase of the client's respirations. Therefore, the correct answer is B, where the ventilator coordinates breath delivery with the client's breathing efforts.

3. A client is in her third month of her first pregnancy. During the interview, she tells the nurse that she has several sex partners and is unsure of the identity of the baby's father. Which of the following nursing interventions is a priority?

• A. Counsel the woman to consent to HIV screening
• B. Perform tests for sexually transmitted diseases
• C. Discuss her high risk for cervical cancer
• D. Refer the client to a family planning clinic

Correct answer: A

Rationale: Counsel the woman to consent to HIV screening. The client's behavior places her at high risk for HIV. Testing is the first step in identifying and managing the risk of HIV infection. Early detection allows for timely interventions and better outcomes. While performing tests for sexually transmitted diseases (choice B) is important, addressing the immediate and potentially life-threatening risk of HIV takes precedence. Discussing the risk for cervical cancer (choice C) is not the priority at this time as HIV screening is more urgent. Referring the client to a family planning clinic (choice D) is not the immediate priority given the client's current high-risk behavior and the need to address the immediate threat of HIV infection.

4. Parents of a 6-month-old breastfed baby ask the nurse about increasing the baby's diet. Which of the following should be added first?

• A. Cereal
• B. Eggs
• C. Meat
• D. Juice

Correct answer: A

Rationale: The correct answer is 'Cereal.' The guidelines of the American Academy of Pediatrics recommend introducing one new food at a time, starting with strained cereal. Cereal is often recommended as a first solid food for infants due to its soft texture and iron-fortified properties, which are important for the baby's development. Eggs and meat are common allergenic foods and are usually introduced later. Juice is not recommended for infants under 1 year old due to its high sugar content and lack of nutritional value compared to whole fruits.

5. How does shock typically progress?

• A. Compensated to hypotensive shock in hours and hypotensive shock to cardiac arrest in minutes
• B. Compensated to hypotensive shock in minutes and hypotensive shock to cardiac arrest in hours
• C. Hypotensive to compensated shock in hours and compensated shock to cardiac arrest in minutes
• D. Hypotensive to compensated shock in minutes and compensated shock to cardiac arrest in hours

Correct answer: A

Rationale: Shock typically progresses from a compensated state to hypotensive shock over a period of hours. In the compensated phase, the body is trying to maintain perfusion. It is crucial to identify and intervene during this phase to prevent progression to hypotensive shock, where blood pressure drops significantly. If not promptly managed, hypotensive shock can rapidly deteriorate into cardiac arrest in minutes due to inadequate perfusion to vital organs. Choices B, C, and D are incorrect as they do not follow the typical progression of shock stages as seen in clinical practice. Understanding the stages of shock and their timeframes is crucial for early recognition and appropriate intervention to prevent further deterioration.

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