Nursing Elites

1. 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.

2. Which patient should the nurse assign as the roommate for a patient who has aplastic anemia?

• A. A patient with chronic heart failure
• B. A patient who has viral pneumonia
• C. A patient who has right leg cellulitis
• D. A patient with multiple abdominal drains

Correct answer: A

Rationale: The correct answer is A because patients with aplastic anemia are at risk for infection due to low white blood cell production. Assigning a roommate with viral pneumonia (choice B), cellulitis (choice C), or multiple abdominal drains (choice D) could expose the patient with aplastic anemia to potential infectious agents, which could further compromise their health.

3. 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.

4. A patient's complete blood count (CBC) shows a hemoglobin of 19 g/dL and a hematocrit of 54%. Which question should the nurse ask to determine possible causes of this finding?

• A. Have you had any recent weight loss?
• B. Do you have any history of lung disease?
• C. Have you noticed any dark or bloody stools?
• D. What is your dietary intake of meats and proteins?

Correct answer: B

Rationale: The correct answer is B: "Do you have any history of lung disease?" The elevated hemoglobin and hematocrit levels suggest polycythemia, which can be seen in conditions like chronic obstructive pulmonary disease (COPD). Option A is less relevant as weight loss is not typically associated with these blood count findings. Option C is more indicative of gastrointestinal bleeding rather than a respiratory issue. Option D focuses on dietary factors, which are less likely to cause such significant elevations in hemoglobin and hematocrit levels as seen in this case.

5. 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.

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