Nursing Elites

1. The nurse assesses a patient with pernicious anemia. Which assessment finding would the nurse expect?

• A. Yellow-tinged sclerae
• B. Shiny, smooth tongue
• C. Numbness of the extremities
• D. Gum bleeding and tenderness

Correct answer: C

Rationale: The correct answer is C: Numbness of the extremities. Numbness of the extremities is a common finding in patients with pernicious anemia, which is caused by cobalamin (vitamin B12) deficiency. This deficiency affects the peripheral nervous system, leading to neurological symptoms like numbness and tingling in the extremities. Choices A, B, and D are incorrect: Yellow-tinged sclerae is more indicative of jaundice or liver dysfunction, a shiny smooth tongue is seen in conditions like glossitis, and gum bleeding and tenderness are associated with periodontal disease or vitamin C deficiency, not pernicious anemia.

2. The health care provider orders a liver and spleen scan for a patient who has been in a motor vehicle crash. Which action should the nurse take before this procedure?

• A. Check for any iodine allergy.
• B. Insert a large-bore IV catheter.
• C. Administer prescribed sedatives.
• D. Assist the patient to a flat position.

Correct answer: D

Rationale: Before a liver and spleen scan, it is essential to assist the patient to a flat position. This position helps obtain clear images of the liver and spleen. Checking for iodine allergy (Choice A) is more relevant for procedures involving contrast dye, not a liver and spleen scan. Inserting a large-bore IV catheter (Choice B) may not be necessary for this specific procedure. Administering sedatives (Choice C) is not typically required for a liver and spleen scan, as the patient needs to remain still during the procedure.

3. A 52-year-old patient has a new diagnosis of pernicious anemia. The nurse determines that the patient understands the teaching about the disorder when the patient states:

• A. I need to start eating more red meat and liver.
• B. I will stop having a glass of wine with dinner.
• C. I could choose nasal spray rather than injections of vitamin B12.
• D. I will need to take a proton pump inhibitor such as omeprazole (Prilosec).

Correct answer: C

Rationale: The correct answer is C. Pernicious anemia is a condition where the body can't absorb enough vitamin B12. Treatment usually involves lifelong replacement of vitamin B12. In this case, the patient understanding the disorder is correctly demonstrated by choosing nasal spray or injections of vitamin B12 for replacement therapy. Choices A, B, and D are incorrect because increasing red meat/liver intake, stopping wine consumption, or taking a proton pump inhibitor like omeprazole do not address the primary issue of vitamin B12 absorption in pernicious anemia.

4. 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: D

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.

5. Which action will the admitting nurse include in the care plan for a patient who has neutropenia?

• A. Avoid intramuscular injections
• B. Check temperature every 4 hours
• C. Omit fruits or vegetables from the diet
• D. Place a 'No Visitors' sign on the door

Correct answer: B

Rationale: The correct answer is B: 'Check temperature every 4 hours.' Neutropenic patients have a weakened immune system due to low levels of neutrophils, which are a type of white blood cell that helps fight infections. Monitoring the patient's temperature every 4 hours is crucial because the earliest sign of infection in a neutropenic patient is often a fever. This allows for early detection of any potential infections. Choices A, C, and D are incorrect because avoiding intramuscular injections, omitting fruits or vegetables from the diet, and placing a 'No Visitors' sign on the door are not specific actions directly related to managing neutropenia or monitoring for signs of infection.

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