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 44-year-old with sickle cell anemia who says his eyes always look sort of yellow

• A. A 23-year-old with no previous health problems who has a nontender lump in the axilla
• B. A 50-year-old with early-stage chronic lymphocytic leukemia who reports chronic fatigue
• C. A 19-year-old with hemophilia who wants to learn to self-administer factor VII replacement
• D. A 44-year-old with sickle cell anemia who says his eyes always look sort of yellow

Correct answer: B

Rationale: Choice B is the correct answer because the scenario describes a 50-year-old with early-stage chronic lymphocytic leukemia who presents with chronic fatigue. Chronic lymphocytic leukemia commonly presents with symptoms like fatigue, weight loss, and enlarged lymph nodes. The other choices are less likely as they do not match the clinical presentation described in the scenario. Choice A describes a 23-year-old with a nontender lump in the axilla, which is more suggestive of a benign condition like a lipoma. Choice C describes a 19-year-old with hemophilia who wants to learn to self-administer factor VII replacement, which is unrelated to the symptoms of chronic lymphocytic leukemia. Choice D repeats the scenario, which is not relevant in selecting the appropriate answer.

3. A patient who has acute myelogenous leukemia develops an absolute neutrophil count of 850/µL while receiving outpatient chemotherapy. Which action by the outpatient clinic nurse is most appropriate?

• A. Discuss the need for hospital admission to treat the neutropenia
• B. Teach the patient to administer filgrastim (Neupogen) injections
• C. Plan to discontinue the chemotherapy until the neutropenia resolves
• D. Order a high-efficiency particulate air (HEPA) filter for the patient's home

Correct answer: B

Rationale: The correct answer is B because filgrastim (Neupogen) is a medication used to stimulate the production of neutrophils. Teaching the patient to self-administer these injections can help increase the neutrophil count and reduce the risk of infection. Option A is incorrect as hospital admission may not be necessary if the patient can manage the condition at home. Option C is not ideal as discontinuing chemotherapy can impact the leukemia treatment. Option D is unrelated to managing neutropenia in this scenario.

4. 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.

5. Which patient statement to the nurse indicates a need for additional instruction about taking oral ferrous sulfate?

• A. I will call my health care provider if my stools turn black.
• B. I will take a stool softener if I feel constipated occasionally.
• C. I should take the iron with orange juice about an hour before eating.
• D. I should increase my fluid and fiber intake while I am taking iron tablets.

Correct answer: A

Rationale: It is normal for the stools to appear black when a patient is taking iron, and the patient should not call the health care provider about this.

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