Nursing Elites

1. The nurse is caring for a patient in the cardiac unit recovering from a cardiac bypass graft procedure. The patient's spouse comes out to the hallway and expresses concern about the patient's confusion since surgery was 3 days ago. An appropriate response by the nurse would be:

• A. Let me call the doctor right away.
• B. What specific concerns do you have?
• C. It is common for confusion to occur after this procedure.
• D. I'll have the counselor come meet you in the room.

Correct answer: C

Rationale: Choice C is the correct answer because confusion can be a common occurrence after cardiac surgeries due to factors such as anesthesia, medication, and the stress of the procedure. By acknowledging the spouse's concern and explaining that confusion is a known potential outcome, the nurse provides reassurance and education. Choices A, B, and D are incorrect because they do not directly address the spouse's concern about the patient's confusion or provide appropriate information about the situation.

2. 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.

3. Which menu choice indicates that the patient understands the nurse's teaching about recommended dietary choices for iron-deficiency anemia?

• A. Omelet and whole wheat toast
• B. Cantaloupe and cottage cheese
• C. Strawberry and banana fruit plate
• D. Cornmeal muffin and orange juice

Correct answer: D

Rationale: The correct answer is D: "Cornmeal muffin and orange juice." Cornmeal muffin is a good source of iron, which is beneficial for individuals with iron-deficiency anemia. Orange juice is high in vitamin C, which aids in iron absorption. Choices A, B, and C do not specifically address the need for iron-rich foods, making them less suitable for someone with iron-deficiency anemia. Omelet and whole wheat toast (Choice A) may provide some iron but are not as focused on addressing the specific deficiency. Cantaloupe and cottage cheese (Choice B) and strawberry and banana fruit plate (Choice C) are more general fruit choices and do not emphasize iron-rich options.

4. The complete blood count (CBC) indicates that a patient is thrombocytopenic. Which action should the nurse include in the plan of care?

• A. Avoid intramuscular injections.
• B. Encourage increased oral fluids.
• C. Check temperature every 4 hours.
• D. Increase intake of iron-rich foods.

Correct answer: A

Rationale: The correct action to include in the plan of care for a thrombocytopenic patient is to avoid intramuscular injections. Thrombocytopenia is a condition characterized by a decreased number of platelets, which are essential for blood clotting. Intramuscular injections can pose a risk of bleeding in patients with low platelet counts. Encouraging increased oral fluids (choice B) is beneficial for hydration but does not directly address the risk of bleeding associated with thrombocytopenia. Checking temperature every 4 hours (choice C) is important for monitoring infection but does not specifically address the risk of bleeding. Increasing intake of iron-rich foods (choice D) is more related to addressing anemia, not the primary concern of bleeding in thrombocytopenia.

5. The nurse is caring for a patient who 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 regularly and avoid individuals who are ill.

Correct answer: D

Rationale: The correct answer is D: 'Wash hands regularly and avoid individuals who are ill.' After a splenectomy, the patient is at an increased risk of infection, particularly from gram-positive bacteria. Proper hand hygiene and avoiding contact with sick individuals are crucial to prevent infections. Choices A, B, and C are incorrect because checking for swollen lymph nodes, watching for excessive bleeding or bruising, and taking iron supplements are not specifically related to the increased infection risk post-splenectomy.

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