Nursing Elites

1. The nurse is educating a patient who was discharged from the hospital after having cardiac surgery one week ago. The nurse recognizes the patient understands medication management when he/she states:

• A. I need to take my Lisinopril daily to reduce my risk of heart failure
• B. I only need to take the metoprolol when I feel my heart skip a beat
• C. I should carry my nitroglycerin pills in my pocket at all times
• D. I should only take the pain pills when my pain is really bad

Correct answer: A

Rationale: The correct answer is A. Lisinopril is commonly prescribed post-cardiac surgery to manage blood pressure and reduce the risk of heart failure. It is important for the patient to take Lisinopril daily as prescribed to achieve optimal outcomes. Choice B is incorrect as metoprolol is usually prescribed on a regular schedule to manage heart conditions, not just when symptoms occur. Choice C is incorrect because nitroglycerin should be kept in a cool, dry place, not in a pocket where it could be exposed to heat or moisture. Choice D is incorrect as pain medication should be taken as prescribed for adequate pain control, not just when pain is severe.

2. A patient with pancytopenia of unknown origin is scheduled for the following diagnostic tests. The nurse will provide a consent form to sign for which test?

• A. Bone marrow biopsy
• B. Abdominal ultrasound
• C. Complete blood count (CBC)
• D. Activated partial thromboplastin time (aPTT)

Correct answer: A

Rationale: In the case of a patient with pancytopenia of unknown origin, a bone marrow biopsy is usually indicated to determine the cause. A bone marrow biopsy is a minor surgical procedure that requires the patient or guardian to sign a surgical consent form. Abdominal ultrasound (Choice B) is not typically used to diagnose pancytopenia. A Complete Blood Count (CBC) (Choice C) is a routine blood test and does not require a specific consent form. Activated Partial Thromboplastin Time (aPTT) (Choice D) is a coagulation test and not typically performed to diagnose pancytopenia.

3. Which patient requires the most rapid assessment and care by the emergency department nurse?

• A. The patient with hemochromatosis who reports abdominal pain
• B. The patient with neutropenia who has a temperature of 101.8°F
• C. The patient with thrombocytopenia who has oozing gums after a tooth extraction
• D. The patient with sickle cell anemia who has had nausea and diarrhea for 24 hours

Correct answer: B

Rationale: The correct answer is B because a neutropenic patient with a fever is at high risk for developing sepsis. Sepsis can progress rapidly and lead to life-threatening complications. Immediate assessment, obtaining cultures, and initiating antibiotic therapy are essential in this situation. Choices A, C, and D do not present with the same level of urgency as a neutropenic patient with a fever. Abdominal pain in a hemochromatosis patient, oozing gums after a tooth extraction in a thrombocytopenic patient, and nausea and diarrhea in a patient with sickle cell anemia, while concerning, do not indicate the same immediate risk of sepsis as a neutropenic patient with a fever.

4. 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.

5. Several patients call the outpatient clinic and ask to make an appointment as soon as possible. Which patient should the nurse schedule to be seen first?

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

Correct answer: B

Rationale: The patient's young age and the presence of a nontender lump in the axilla raise concerns for possible lymphoma, which requires prompt evaluation and treatment. This patient should be seen first to rule out any serious underlying condition. Choice A is less urgent as yellowish eyes in sickle cell anemia may be due to jaundice but not necessarily an acute issue. Choice C, a 50-year-old with chronic fatigue related to early-stage chronic lymphocytic leukemia, is a known condition that can be managed on a routine basis. Choice D, a 19-year-old with hemophilia wanting to self-administer factor VII replacement, is important but less urgent compared to the potential lymphoma presentation in choice B.

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