Nursing Elites

1. The patient in the emergency room has a history of alprazolam (Xanax) abuse and abruptly stopped taking Xanax about 24 hours ago. He presents with visible tremors, pacing, fear, impaired concentration, and memory. Which intervention takes priority?

• A. Have the patient lie down on a stretcher with bed rails raised
• B. Offer the patient a cup of water and a small amount of food
• C. Reassure the patient about his well-being
• D. Inform the physician about the patient's Xanax withdrawal

Correct answer: A

Rationale: The 1-4 day period after Xanax withdrawal is critical as it poses the highest risk of life-threatening seizures. Alprazolam is a benzodiazepine, and sudden cessation can lead to severe withdrawal symptoms. The patient's visible tremors, fear, pacing, and cognitive impairment indicate a state of heightened distress and potential seizure risk. Placing the patient on a stretcher with raised bed rails is essential for seizure precautions, ensuring safety and preventing injury during a potential seizure. Offering water and food, reassuring the patient, or informing the physician about Xanax withdrawal are not immediate priorities compared to managing the risk of seizures in this high-risk situation.

2. A newborn has been diagnosed with hypothyroidism. In discussing the condition and treatment with the family, the nurse should emphasize:

• A. They can expect the child will be mentally retarded.
• B. Administration of thyroid hormone will prevent problems.
• C. This rare problem is always hereditary.
• D. Physical growth/development will be delayed.

Correct answer: B

Rationale: The correct answer is administration of thyroid hormone will prevent problems. In newborns diagnosed with hypothyroidism, early identification and continuous treatment with hormone replacement can correct this condition effectively. Choice A is incorrect as it uses outdated and inappropriate language (mentally retarded) and does not reflect modern understanding of conditions. Choice C is incorrect because while some cases of hypothyroidism can be hereditary, it is not always the case. Choice D is incorrect as physical growth and development can be affected by hypothyroidism, but the critical emphasis should be on the importance of administering thyroid hormone to prevent complications and support normal growth and development.

3. The nurse is planning care for a 48-year-old woman with acute severe pancreatitis. The highest priority patient outcome is

• A. maintaining normal respiratory function.
• B. expressing satisfaction with pain control.
• C. developing no ongoing pancreatic disease.
• D. having adequate fluid and electrolyte balance.

Correct answer: A

Rationale: In acute severe pancreatitis, there is a risk of respiratory failure as a complication, making the maintenance of normal respiratory function the priority outcome. This patient may develop respiratory issues due to the inflammatory process affecting the diaphragm. While pain control, absence of ongoing pancreatic disease, and fluid/electrolyte balance are crucial, they are secondary to ensuring adequate oxygenation and ventilation to prevent respiratory compromise.

4. A nurse frequently treats patients in the 72-hour period after a stroke has occurred. The nurse would be most concerned about which of these assessment findings?

• A. INR is 3 seconds long
• B. Heart rate is 110 beats per minute
• C. Intracranial Pressure is 22 mmHg
• D. Blood pressure is 140/80

Correct answer: C

Rationale: The nurse would be most concerned about the assessment finding of an Intracranial Pressure (ICP) reading of 22 mmHg in a patient 72 hours post-stroke. Elevated ICP can indicate increased risk of edema and further brain damage. A target ICP should ideally be maintained at less than or equal to 15-20 mmHg. While the other options may also be important to monitor, an elevated ICP poses a more immediate threat to the patient's neurological status and requires prompt attention.

5. Following surgery to correct cryptorchidism, what is the priority action that the nurse should include in the plan of care?

• A. Prevent tension on the suture.
• B. Monitor urine for glucose and acetone.
• C. Encourage oral fluids, and monitor intake and output.
• D. Encourage coughing and deep breathing every hour.

Correct answer: A

Rationale: The correct answer is to prevent tension on the suture. After surgery for cryptorchidism, the testicle is held in position by an internal suture that should not be dislodged. Immobilization of the area for a week is crucial to prevent complications like bleeding and infection. Monitoring urine for glucose and acetone is unrelated to this surgery. While maintaining hydration is important, forcing fluids is not necessary. Encouraging coughing and deep breathing every hour may be a postoperative consideration, but it is not the priority for this specific surgery.

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