Nursing Elites

1. If your patient is acutely psychotic, which of the following independent nursing interventions would not be appropriate?

• A. Conveying calmness through one-on-one interaction
• B. Recognizing and managing your own feelings to prevent escalation of the patient's anxiety level
• C. Encouraging client participation in group therapy
• D. Listening and identifying causes of their behavior

Correct answer: C

Rationale: When a patient is acutely psychotic, they may not be able to effectively participate in group therapy due to their altered mental state. Group settings can be overwhelming and may exacerbate the patient's symptoms. Choices A, B, and D are appropriate interventions. Choice A is correct as providing calmness through one-on-one interaction can be beneficial in establishing trust and reducing anxiety. Choice B is also important as recognizing and managing the nurse's feelings can prevent further escalation of the patient's symptoms. Choice D is relevant as listening and identifying causes of the patient's behavior can aid in understanding and providing appropriate care tailored to the patient's needs.

2. Which of the following is an inappropriate item to include in planning care for a severely neutropenic client?

• A. Transfuse neutrophils (granulocytes) to prevent infection.
• B. Exclude raw vegetables from the diet.
• C. Avoid administering rectal suppositories.
• D. Prohibit vases of fresh flowers and plants in the client's room.

Correct answer: A

Rationale: The correct answer is to transfuse neutrophils (granulocytes) to prevent infection. Granulocyte transfusion is not routinely indicated to prevent infection in neutropenic clients. While neutrophils are essential in fighting infections and are beneficial in selected populations of infected, severely granulocytopenic clients who do not respond to antibiotics and are expected to experience prolonged suppression of granulocyte production, routine granulocyte transfusion is not recommended. Choices B, C, and D are appropriate interventions for a severely neutropenic client. Prohibiting fresh flowers and plants helps reduce the risk of exposure to environmental pathogens. Avoiding rectal suppositories minimizes the risk of introducing harmful bacteria. Excluding raw vegetables from the diet reduces the likelihood of foodborne infections.

3. Which deficiency in the mother has been primarily associated with neural tube defects in the fetus?

• A. Iron
• B. Folic acid
• C. Vitamin B12
• D. Vitamin E

Correct answer: B

Rationale: Folic acid deficiency in the mother has been primarily associated with neural tube defects in the fetus. Folic acid is crucial for the development of the neural tube in the early stages of pregnancy. Its deficiency can lead to neural tube defects, such as spina bifida or anencephaly. Iron deficiency is not directly related to neural tube defects but can cause other complications in pregnancy. Vitamin B12 is important for neurological function but is not the primary cause of neural tube defects. Vitamin E deficiency is not associated with neural tube defects in the fetus.

4. Erythropoietin used to treat anemia in clients with renal failure should be given in conjunction with:

• A. iron, folic acid, and B12.
• B. an increase in protein in the diet.
• C. vitamins A and C.
• D. an increase in calcium in the diet.

Correct answer: A

Rationale: Erythropoietin is necessary for red blood cell (RBC) production, and in clients with renal failure who lack endogenous erythropoietin, exogenous erythropoietin is administered. However, for erythropoietin to effectively stimulate RBC production, adequate levels of iron, folic acid, and vitamin B12 are crucial. These nutrients are essential for RBC synthesis and maturation. Therefore, the correct answer is to give iron, folic acid, and B12 with erythropoietin. Choice B, an increase in protein in the diet, is not necessary for RBC production and may exacerbate uremia in clients with renal failure. Choices C and D, vitamins A and C, and an increase in calcium in the diet, respectively, are not directly related to RBC production and are not required to enhance the effectiveness of erythropoietin.

5. A patient had a pneumonectomy to the right lung performed 48 hours ago. Which of the following conditions most likely exists?

• A. Decreased breath sound volume
• B. Elevated tidal volume
• C. Elevated respiratory capacity
• D. Wheezing

Correct answer: A

Rationale: After a pneumonectomy, where a lung is surgically removed, there will be a decrease in breath sound volume on the affected side due to reduced airflow. This reduction in breath sound volume is expected as there is less lung tissue to produce sound. Choices B, C, and D are incorrect. Elevated tidal volume and respiratory capacity are not expected after a pneumonectomy, and wheezing is more commonly associated with conditions like asthma or bronchitis, not a recent pneumonectomy.

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