Nursing Elites

1. The health care provider's progress note for a patient states that the complete blood count (CBC) shows a 'shift to the left.' Which assessment finding will the nurse expect?

• A. Cool extremities
• B. Pallor and weakness
• C. Elevated temperature
• D. Low oxygen saturation

Correct answer: C

Rationale: The correct answer is C: Elevated temperature. When a CBC shows a 'shift to the left,' it indicates elevated levels of immature polymorphonuclear neutrophils (bands), which is a sign of infection. In response to the infection, the body increases its temperature as part of the immune response. Choices A, B, and D are incorrect because cool extremities, pallor and weakness, and low oxygen saturation are not typically associated with a 'shift to the left' in a CBC; they are more indicative of other conditions or issues.

2. The nurse notes pallor of the skin and nail beds in a newly admitted patient. The nurse should ensure that which laboratory test has been ordered?

• A. Platelet count
• B. Neutrophil count
• C. Hemoglobin level
• D. White blood cell count

Correct answer: C

Rationale: The correct answer is C, 'Hemoglobin level.' Pallor of the skin and nail beds is a sign of anemia, which is characterized by a low hemoglobin level. Anemia is a condition where there is a decreased number of red blood cells or hemoglobin in the blood, leading to reduced oxygen-carrying capacity. Checking the hemoglobin level would help confirm the presence and severity of anemia, guiding further diagnostic and treatment interventions. Choices A, B, and D are incorrect because platelet count, neutrophil count, and white blood cell count are not typically associated with the pallor of the skin and nail beds, which are more indicative of an underlying anemic condition.

3. Which collaborative problem will the nurse include in a care plan for a patient admitted to the hospital with idiopathic aplastic anemia?

• A. Potential complication: seizures
• B. Potential complication: infection
• C. Potential complication: neurogenic shock
• D. Potential complication: pulmonary edema

Correct answer: B

Rationale: The correct answer is B: Potential complication: infection. Patients with idiopathic aplastic anemia have pancytopenia, which puts them at a high risk for infections due to decreased production of all blood cells (red blood cells, white blood cells, and platelets). Infection is a significant concern in these patients. Choices A, C, and D are incorrect because seizures, neurogenic shock, and pulmonary edema are not typically associated with idiopathic aplastic anemia. While seizures can occur in some conditions that affect the brain, neurogenic shock is related to spinal cord injury, and pulmonary edema is more commonly seen in conditions like heart failure.

4. A patient is being discharged after an emergency splenectomy following a motor vehicle crash. Which instructions should the nurse include in the discharge teaching?

• A. Check frequently for swollen lymph nodes.
• B. Watch for excessive bleeding or bruising.
• C. Take iron supplements to prevent anemia.
• D. Wash hands and avoid individuals who are ill.

Correct answer: D

Rationale: The correct answer is D. After a splenectomy, the patient is at an increased risk of infection, particularly from gram-positive bacteria. Washing hands and avoiding contact with individuals who are ill are crucial to reduce this risk. Choice A is incorrect because checking for swollen lymph nodes is not a priority after a splenectomy. Choice B is incorrect as while bleeding is a concern, it is more immediate post-operatively. Choice C is incorrect as iron supplements do not specifically relate to the risk of infection post-splenectomy.

5. The nurse is planning to administer a transfusion of packed red blood cells (PRBCs) to a patient with blood loss from gastrointestinal hemorrhage. Which action can the nurse delegate to unlicensed assistive personnel (UAP)?

• A. Verify the patient identification (ID) according to hospital policy
• B. Obtain the temperature, blood pressure, and pulse before the transfusion
• C. Double-check the product numbers on the PRBCs with the patient ID band
• D. Monitor the patient for shortness of breath or chest pain during the transfusion

Correct answer: B

Rationale: The correct answer is B. Unlicensed assistive personnel (UAP) can obtain the temperature, blood pressure, and pulse before a transfusion as their education includes measurement of vital signs. UAP would then report the vital signs to the registered nurse (RN). Option A is typically a nursing responsibility to ensure patient safety and avoid errors in patient identification. Option C involves cross-checking important details and ensuring accuracy, which is usually performed by nursing staff to prevent errors. Option D requires monitoring for potential adverse reactions during the transfusion, which is a nursing responsibility due to the need for assessment and intervention in case of complications.

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