Nursing Elites

1. A patient with a pleural effusion is scheduled for a thoracentesis. Which action should the nurse take to prepare the patient for the procedure?

• A. Start a peripheral IV line to administer any necessary sedative drugs.
• B. Position the patient sitting upright on the edge of the bed and leaning forward.
• C. Obtain a collection device to hold a reasonable amount of pleural fluid for extraction.
• D. Remove the water pitcher and remind the patient not to eat or drink anything for 6 hours.

Correct answer: B

Rationale: The correct action for the nurse to take in preparing a patient for a thoracentesis is to position the patient sitting upright on the edge of the bed and leaning forward. This position helps fluid accumulate at the lung bases, making it easier to locate and remove. Sedation is not usually required for a thoracentesis, so starting an IV line for sedative drugs is unnecessary. Additionally, there are no restrictions on oral intake before the procedure since the patient is not sedated or unconscious. A large collection device to hold 2 to 3 liters of pleural fluid at one time is excessive as usually only 1000 to 1200 mL of pleural fluid is removed to avoid complications like hypotension, hypoxemia, or pulmonary edema. Therefore, the correct choice is to position the patient upright for the procedure.

2. The patient is being taught about pulmonary function testing (PFT). Which statement made by the patient indicates effective teaching?

• A. I will use my inhaler right before the test.
• B. I won't eat or drink anything 8 hours before the test.
• C. I should inhale deeply and blow out as hard as I can during the test.
• D. My blood pressure and pulse will be checked every 15 minutes after the test.

Correct answer: C

Rationale: The correct answer is 'I should inhale deeply and blow out as hard as I can during the test.' This statement indicates effective teaching because for PFT, the patient needs to inhale deeply and exhale forcefully. This maneuver helps in assessing lung function accurately. Choices A, B, and D are incorrect. Using an inhaler right before the test may alter the test results, which is not recommended. Fasting for 8 hours is not necessary for a PFT, and checking blood pressure and pulse every 15 minutes after the test is not part of the PFT procedure.

3. A newborn has been diagnosed with hypothyroidism. In discussing the condition and treatment with the family, the nurse should emphasize:

• A. They can expect the child will be mentally retarded.
• B. Administration of thyroid hormone will prevent problems.
• C. This rare problem is always hereditary.
• D. Physical growth/development will be delayed.

Correct answer: B

Rationale: The correct answer is administration of thyroid hormone will prevent problems. In newborns diagnosed with hypothyroidism, early identification and continuous treatment with hormone replacement can correct this condition effectively. Choice A is incorrect as it uses outdated and inappropriate language (mentally retarded) and does not reflect modern understanding of conditions. Choice C is incorrect because while some cases of hypothyroidism can be hereditary, it is not always the case. Choice D is incorrect as physical growth and development can be affected by hypothyroidism, but the critical emphasis should be on the importance of administering thyroid hormone to prevent complications and support normal growth and development.

4. The nurse is caring for a patient in the ICU who has had a spinal cord injury. She observes that his last blood pressure was 100/55, and his pulse is 48. These have both trended downwards from the baseline. What should the nurse expect to be the next course of action ordered by the physician?

• A. Assess the patient for decreased level of consciousness
• B. Administer Normal Saline
• C. Insert an NG Tube
• D. Connect and read an EKG

Correct answer: B

Rationale: The patient is entering neurogenic shock due to the spinal cord injury, leading to hypotension and bradycardia. Administering Normal Saline is essential to replace fluid volume, which can help in treating the hypotension and bradycardia symptomatically. This intervention aims to stabilize the patient's cardiovascular status. Assessing for decreased level of consciousness (Choice A) may be important but addressing the hemodynamic instability takes precedence. Inserting an NG Tube (Choice C) and connecting and reading an EKG (Choice D) are not the immediate actions required for the presenting symptoms of hypotension and bradycardia.

5. Which of the following diseases or disorders is acute?

• A. Pneumonia
• B. Paralysis
• C. Alzheimer's disease
• D. Diabetes

Correct answer: A

Rationale: The correct answer is Pneumonia. Pneumonia is an acute illness characterized by inflammation of the air sacs in the lungs. It comes on suddenly and typically lasts for a short duration. Treatment can help cure pneumonia. Paralysis, Alzheimer's disease, and Diabetes are chronic conditions. Paralysis is the loss of muscle function in part of the body, usually permanent. Alzheimer's disease is a progressive brain disorder leading to memory loss and cognitive decline, and it is incurable. Diabetes is a chronic condition that affects how your body turns food into energy, and it requires lifelong management. Therefore, Pneumonia is the only acute condition among the options provided.

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