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. A healthcare provider reviews the laboratory data for an older patient. The healthcare provider would be most concerned about which finding?

• A. Hematocrit of 35%
• B. Hemoglobin of 11.8 g/dL
• C. Platelet count of 400,000/μL
• D. White blood cell (WBC) count of 2800/μL

Correct answer: D

Rationale: A low white blood cell (WBC) count in an older patient is concerning as it indicates a potential compromise in the patient's immune function. White blood cells are crucial for fighting infections and a low count could lead to an increased risk of infections. Hematocrit, hemoglobin, and platelet count are important parameters to assess, but a low WBC count takes priority in this case due to its direct impact on immune health.

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. A patient is considering options to manage his/her coronary artery disease. The nurse explains a coronary artery bypass graft procedure will:

• A. Cure the patient's coronary artery disease.
• B. Replace the leaking valve in the heart.
• C. Connect grafts to aorta to improve blood flow.
• D. Place a permanent pacemaker on the heart muscle.

Correct answer: C

Rationale: The correct answer is C. A coronary artery bypass graft procedure involves connecting grafts to the aorta to improve blood flow to the heart muscle by bypassing blocked or narrowed coronary arteries. This procedure does not cure coronary artery disease but helps improve blood supply to the heart. Choices A, B, and D are incorrect because a bypass graft procedure does not cure the underlying disease, replace heart valves, or involve the placement of a pacemaker.

5. After a patient with pancytopenia undergoes a bone marrow aspiration from the left posterior iliac crest, which action would be important for the nurse to take?

• A. Elevate the head of the bed to 45 degrees.
• B. Have the patient lie on the left side for 1 hour.
• C. Apply a sterile 2-inch gauze dressing to the site.
• D. Use a half-inch sterile gauze to pack the wound.

Correct answer: B

Rationale: After a bone marrow aspiration, it is important to have the patient lie on the left side for 30 to 60 minutes to decrease the risk of bleeding. Elevating the head of the bed to 45 degrees does not directly address the risk of bleeding. Applying a sterile 2-inch gauze dressing to the site is important for wound care but does not specifically address post-procedural positioning. Using a half-inch sterile gauze to pack the wound is not necessary after a bone marrow aspiration.

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