Nursing Elites

1. A patient with a history of diabetes mellitus is on the second postoperative day following cholecystectomy. She has complained of nausea and isn't able to eat solid foods. The nurse enters the room to find the patient confused and shaky. Which of the following is the most likely explanation for the patient's symptoms?

• A. Anesthesia reaction
• B. Hyperglycemia
• C. Hypoglycemia
• D. Diabetic ketoacidosis

Correct answer: C

Rationale: In a postoperative diabetic patient who is unable to eat solid foods, the likely cause of symptoms such as confusion and shakiness is hypoglycemia. Confusion and shakiness are common manifestations of hypoglycemia. Insufficient glucose supply to the brain (neuroglycopenia) can lead to confusion, difficulty with concentration, irritability, hallucinations, focal impairments like hemiplegia, and, in severe cases, coma and death. Anesthesia reaction (Choice A) is less likely in this scenario as the patient is already on the second postoperative day. Hyperglycemia (Choice B) is unlikely given the patient's symptoms and history of not eating. Diabetic ketoacidosis (Choice D) typically presents with hyperglycemia, ketosis, and metabolic acidosis, which are not consistent with the patient's current symptoms of confusion and shakiness.

2. To prevent a Valsalva maneuver in a client recovering from an acute myocardial infarction, the nurse would:

• A. Assist the client in using the bedside commode.
• B. Administer stool softeners daily as prescribed.
• C. Administer antidysrhythmics prn as ordered.
• D. Maintain the client on strict bed rest.

Correct answer: B

Rationale: Administering stool softeners daily is crucial to prevent straining during defecation, which can lead to the Valsalva maneuver. Straining can increase intrathoracic pressure, decrease venous return to the heart, and reduce cardiac output, potentially worsening the client's condition. If constipation occurs, the use of laxatives may be necessary to avoid straining. Administering antidysrhythmics on an as-needed basis is not indicated for preventing the Valsalva maneuver; they are used to manage dysrhythmias. Strict bed rest is not necessary and may lead to complications such as deconditioning, DVT, and respiratory issues in the absence of specific medical indications.

3. A client is scheduled for a percutaneous transluminal coronary angioplasty (PTCA). The nurse knows that a PTCA is

• A. Surgical repair of a diseased coronary artery.
• B. Placement of an automatic internal cardiac defibrillator.
• C. Procedure that compresses plaque against the wall of the diseased coronary artery to improve blood flow.
• D. Non-invasive radiographic examination of the heart.

Correct answer: C

Rationale: Percutaneous transluminal coronary angioplasty (PTCA) is a procedure that involves compressing plaque against the wall of a diseased coronary artery to improve blood flow. It is a minimally invasive procedure performed during a cardiac catheterization to open blockages in the coronary arteries. Surgical repair of a diseased coronary artery refers to procedures like coronary artery bypass grafting (CABG), not PTCA. Placement of an automatic internal cardiac defibrillator is a different intervention used for managing cardiac arrhythmias, not for improving coronary blood flow. A non-invasive radiographic examination of the heart would typically refer to procedures like a cardiac CT scan or an MRI, not PTCA.

4. A 65-year-old man is prescribed Flomax (Tamsulosin) for Benign Prostatic Hyperplasia. The patient lives in an upstairs apartment. The nurse is most concerned about which side effect of Flomax?

• A. Hypotension
• B. Tachycardia
• C. Back Pain
• D. Difficulty Urinating

Correct answer: A

Rationale: The correct answer is 'Hypotension.' Flomax (Tamsulosin) is known to cause orthostatic hypotension, especially in the elderly, leading to a sudden drop in blood pressure when standing up. This side effect can result in dizziness, falls, and injury, especially concerning for a patient living in an upstairs apartment. Tachycardia (increased heart rate) and back pain are less commonly associated with Flomax use, while difficulty urinating is a symptom that Flomax is intended to improve in patients with Benign Prostatic Hyperplasia.

5. To palpate the liver during a head-to-toe physical assessment, the nurse should

• A. put pressure on the biopsy site using a sandbag
• B. elevate the head of the bed to facilitate breathing
• C. place the patient on the right side with the bed flat
• D. check the patient's post-biopsy coagulation studies

Correct answer: C

Rationale: To palpate the liver effectively during a head-to-toe physical assessment, the patient should be positioned on the right side with the bed flat. This position helps to splint the biopsy site and allows for proper palpation of the liver. Elevating the head of the bed has no direct relevance to palpating the liver. Checking coagulation studies is done before the biopsy and is unrelated to palpation. Putting pressure on the biopsy site using a sandbag is not an appropriate way to facilitate liver palpation as it does not provide the necessary support and stabilization needed for the procedure.

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