Nursing Elites

1. Several patients call the outpatient clinic and ask to make an appointment as soon as possible. Which patient should the nurse schedule to be seen first?

• A. A 44-year-old with sickle cell anemia who reports his eyes always look somewhat yellow
• B. A 23-year-old with no previous health problems who has a nontender lump in the axilla
• C. A 50-year-old with early-stage chronic lymphocytic leukemia who reports chronic fatigue
• D. A 19-year-old with hemophilia who wants to learn to self-administer factor VII replacement

Correct answer: B

Rationale: The patient's young age and the presence of a nontender lump in the axilla raise concerns for possible lymphoma, which requires prompt evaluation and treatment. This patient should be seen first to rule out any serious underlying condition. Choice A is less urgent as yellowish eyes in sickle cell anemia may be due to jaundice but not necessarily an acute issue. Choice C, a 50-year-old with chronic fatigue related to early-stage chronic lymphocytic leukemia, is a known condition that can be managed on a routine basis. Choice D, a 19-year-old with hemophilia wanting to self-administer factor VII replacement, is important but less urgent compared to the potential lymphoma presentation in choice B.

2. During a physical assessment, the nurse examines the lymph nodes of a patient. Which assessment finding would be of most concern to the nurse?

• A. A 2-cm nontender supraclavicular node
• B. A 1-cm mobile and nontender axillary node
• C. An inability to palpate any superficial lymph nodes
• D. Firm inguinal nodes in a patient with an infected foot

Correct answer: A

Rationale: The correct answer is A. A 2-cm nontender supraclavicular node is of most concern because enlarged and nontender nodes in this area are highly suggestive of malignancies such as lymphoma. Choice B is less concerning as a 1-cm mobile and nontender axillary node is usually benign. Choice C, an inability to palpate any superficial lymph nodes, could be due to factors like obesity or edema, but it is not necessarily a cause for immediate concern. Choice D, firm inguinal nodes in a patient with an infected foot, may indicate a local reaction to infection rather than a systemic issue related to malignancy.

3. A patient with immune thrombocytopenic purpura (ITP) has an order for a platelet transfusion. Which information indicates that the nurse should consult with the healthcare provider before obtaining and administering platelets?

• A. Platelet count is 42,000/µL
• B. Petechiae are present on the chest
• C. Blood pressure (BP) is 94/56 mm Hg
• D. Blood is oozing from the venipuncture site

Correct answer: A

Rationale: The correct answer is A. Platelet transfusions are not usually indicated until the platelet count is below 10,000 to 20,000/µL unless the patient is actively bleeding. In this case, with a platelet count of 42,000/µL, the count is not critically low, and the patient is not actively bleeding. Therefore, the nurse should consult with the healthcare provider before giving the transfusion. Choices B, C, and D are incorrect because the presence of petechiae, low blood pressure, and oozing from the venipuncture site are common findings in patients with ITP and do not necessarily require immediate consultation before administering a platelet transfusion.

4. The nurse reviews the laboratory test results of a patient admitted with abdominal pain. Which information will be most important for the nurse to communicate to the health care provider?

• A. Monocytes 4%
• B. Hemoglobin 13.6 g/dL
• C. Platelet count 168,000/μL
• D. White blood cell (WBC) count 15,500/μL

Correct answer: A

Rationale: The correct answer is A. A low percentage of monocytes can indicate a viral infection. This is crucial information to communicate as it suggests a specific type of infection that may require targeted treatment. Choices B, C, and D do not directly relate to an infectious process and are within normal ranges, so they are not as urgent to communicate to the healthcare provider in this context.

5. When providing care for a patient with sickle cell crisis, what is important for the nurse to do?

• A. Monitor the patient's intake of oral and IV fluids
• B. Evaluate the effectiveness of opioid analgesics
• C. Encourage the patient to ambulate as much as tolerated
• D. Educate the patient about high-protein, high-calorie foods

Correct answer: B

Rationale: The correct answer is to evaluate the effectiveness of opioid analgesics. In sickle cell crisis, pain is the most common symptom and is usually managed with large doses of continuous opioids. Monitoring fluid intake (Choice A) is important, but limiting fluids may not be necessary. Encouraging ambulation (Choice C) is generally good but may not be the priority during a sickle cell crisis. Educating the patient about nutrition (Choice D) is important for overall health but may not be the immediate focus during a crisis.

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