Nursing Elites

1. An appropriate nursing intervention for a patient with non-Hodgkin's lymphoma whose platelet count drops to 18,000/µL during chemotherapy is to

• A. check all stools for occult blood
• B. encourage fluids to 3000 mL/day
• C. provide oral hygiene every 2 hours
• D. check the temperature every 4 hours

Correct answer: A

Rationale: The correct answer is to check all stools for occult blood. With a platelet count of 18,000/µL, the patient is at a high risk of spontaneous bleeding. Checking stools for occult blood can help detect any internal bleeding early. Encouraging fluids and providing oral hygiene are important interventions in general, but in this case, monitoring for bleeding takes precedence. Checking the temperature every 4 hours is not directly related to the patient's current condition and platelet count.

2. Which patient requires the most rapid assessment and care by the emergency department nurse?

• A. The patient with hemochromatosis who reports abdominal pain
• B. The patient with neutropenia who has a temperature of 101.8°F
• C. The patient with thrombocytopenia who has oozing gums after a tooth extraction
• D. The patient with sickle cell anemia who has had nausea and diarrhea for 24 hours

Correct answer: B

Rationale: The correct answer is B because a neutropenic patient with a fever is at high risk for developing sepsis. Sepsis can progress rapidly and lead to life-threatening complications. Immediate assessment, obtaining cultures, and initiating antibiotic therapy are essential in this situation. Choices A, C, and D do not present with the same level of urgency as a neutropenic patient with a fever. Abdominal pain in a hemochromatosis patient, oozing gums after a tooth extraction in a thrombocytopenic patient, and nausea and diarrhea in a patient with sickle cell anemia, while concerning, do not indicate the same immediate risk of sepsis as a neutropenic patient with a fever.

3. The nurse is reviewing laboratory results and notes a patient's activated partial thromboplastin time (aPTT) level of 28 seconds. The nurse should notify the health care provider in anticipation of adjusting which medication?

• A. Aspirin
• B. Heparin
• C. Warfarin
• D. Erythropoietin

Correct answer: B

Rationale: The correct answer is B: Heparin. An activated partial thromboplastin time (aPTT) level of 28 seconds indicates a prolonged time, which is associated with heparin administration. Heparin is an anticoagulant medication that affects the intrinsic pathway of the coagulation cascade, leading to an increased aPTT. Aspirin (choice A) affects platelet aggregation and does not directly impact aPTT. Warfarin (choice C) affects the extrinsic pathway of the coagulation cascade and is monitored using the international normalized ratio (INR), not aPTT. Erythropoietin (choice D) is not related to coagulation parameters.

4. The nurse assesses a patient who has numerous petechiae on both arms. Which question should the nurse ask the patient?

• A. Are you taking any oral contraceptives?
• B. Have you been prescribed antiseizure drugs?
• C. Do you take medication containing salicylates?
• D. How long have you been taking antihypertensive drugs?

Correct answer: C

Rationale: The correct answer is C: 'Do you take medication containing salicylates?' Petechiae are tiny, pinpoint, red or purple spots on the skin due to bleeding under the skin. Salicylates, which are found in medications like aspirin, interfere with platelet function and can lead to petechiae and ecchymoses. Asking about salicylate-containing medications is crucial in this situation. Choices A, B, and D are incorrect because they are not directly related to the development of petechiae.

5. The nurse is caring for a patient post coronary artery bypass graft who rates his/her pain as an 8 out of 10 on the subjective pain scale. Should the nurse choose to administer morphine sulfate intravenously as it has benefits to cardiac patients (select one that does not apply)?

• A. Decreasing myocardial oxygen supply
• B. Decreasing myocardial oxygen consumption
• C. Decreasing heart rate
• D. Increasing blood pressure

Correct answer: Increasing blood pressure

Rationale: Morphine sulfate, a potent opioid analgesic, can cause vasodilation leading to a decrease in blood pressure rather than an increase. Choice A is incorrect as morphine can decrease myocardial oxygen consumption by reducing the workload of the heart. Choice B is incorrect as morphine can decrease heart rate as a side effect. Choice C is incorrect as morphine typically decreases blood pressure rather than increasing it.

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