Nursing Elites

1. When assessing a patient who has just arrived after an automobile accident, the emergency department nurse notes tachycardia and absent breath sounds over the right lung. For which intervention will the nurse prepare the patient?

• A. Emergency pericardiocentesis
• B. Stabilization of the chest wall with tape
• C. Administration of an inhaled bronchodilator
• D. Insertion of a chest tube with a chest drainage system

Correct answer: D

Rationale: The patient's history and absent breath sounds suggest a right-sided pneumothorax or hemothorax, which will require treatment with a chest tube and drainage. Emergency pericardiocentesis is not indicated as the patient's symptoms are not suggestive of cardiac tamponade. Stabilization of the chest wall with tape would not address the underlying issue of a potential pneumothorax or hemothorax. Administration of an inhaled bronchodilator is not appropriate in this scenario as the patient is not exhibiting signs of asthma or bronchoconstriction. Therefore, the correct intervention for this patient is the insertion of a chest tube with a chest drainage system to address the potential pneumothorax or hemothorax.

2. A client is scheduled for an Intravenous Pyelogram (IVP). In order to prepare the client for this test, the nurse would:

• A. Instruct the client to maintain a regular diet the day prior to the examination.
• B. Restrict the client's fluid intake 4 hours prior to the examination.
• C. Administer a laxative to the client the evening before the examination.
• D. Inform the client that only 1 x-ray of his abdomen is necessary.

Correct answer: C

Rationale: The correct preparation for an Intravenous Pyelogram (IVP) involves administering a laxative to the client the evening before the examination. This is crucial to ensure adequate bowel preparation, which in turn allows for better visualization of the bladder and ureters during the procedure. An IVP is an x-ray exam that utilizes contrast material to evaluate the kidneys, ureters, and bladder, aiding in the diagnosis of conditions like blood in the urine or pain in the side or lower back. Administering a laxative helps in achieving optimal imaging quality, which is essential for accurate diagnosis and subsequent treatment planning. Choice A is incorrect because maintaining a regular diet is not the standard preparation for an IVP. Choice B is incorrect as fluid intake is not typically restricted for this procedure. Choice D is incorrect as an IVP involves multiple x-rays to assess the urinary system, not just one of the abdomen.

3. The healthcare provider is caring for a 20 lbs (9 kg) 6-month-old with a 3-day history of diarrhea, occasional vomiting, and fever. Peripheral intravenous therapy has been initiated, with 5% dextrose in 0.33% normal saline with 20 mEq of potassium per liter infusing at 35 ml/hr. Which finding should be reported to the healthcare provider immediately?

• A. 3 episodes of vomiting in 1 hour
• B. Periodic crying and irritability
• C. Vigorous sucking on a pacifier
• D. No measurable voiding in 4 hours

Correct answer: D

Rationale: The correct answer is 'No measurable voiding in 4 hours.' This finding should be reported to the healthcare provider immediately. The concern is the possibility of hyperkalemia, which could occur with continued potassium administration and a decrease in urinary output since potassium is excreted via the kidneys. It is crucial to monitor urinary output in pediatric patients receiving potassium-containing IV solutions to prevent electrolyte imbalances and potential complications. Choices A, B, and C are not the most critical findings that require immediate reporting. '3 episodes of vomiting in 1 hour' may suggest a need for antiemetic therapy or further assessment of the underlying cause but does not pose an immediate risk like the potential electrolyte imbalance from decreased urinary output. 'Periodic crying and irritability' and 'Vigorous sucking on a pacifier' are common behaviors in infants and are not indicative of a critical condition that requires urgent attention in this scenario.

4. The nurse completes discharge teaching for a patient who has had a lung transplant. The nurse evaluates that the teaching has been effective if the patient makes which statement?

• A. I will make an appointment to see the doctor every year.
• B. I will stop taking the prednisone if I experience a dry cough.
• C. I will not worry if I feel a little short of breath with exercise.
• D. I will call the health care provider right away if I develop a fever.

Correct answer: D

Rationale: The correct answer is, 'I will call the health care provider right away if I develop a fever.' It is crucial for patients who have undergone a lung transplant to be vigilant about any signs of infection or rejection. A low-grade fever can be an early indicator of such complications, requiring immediate medical attention. While annual follow-up visits are necessary, they are not sufficient for monitoring acute changes in health post-transplant. Stopping prednisone abruptly can lead to rejection and should only be done under healthcare provider guidance. Feeling short of breath with exercise should be reported as it can indicate potential issues. Recognizing and addressing symptoms promptly is key to successful post-transplant care, and in this case, calling the healthcare provider immediately for a fever is the most appropriate action.

5. A patient with acute shortness of breath is admitted to the hospital. Which action should the nurse take during the initial assessment of the patient?

• A. Ask the patient to lie down to complete a full physical assessment.
• B. Briefly ask specific questions about this episode of respiratory distress.
• C. Complete the admission database to check for allergies before treatment.
• D. Delay the physical assessment to first complete pulmonary function tests.

Correct answer: B

Rationale: When a patient presents with acute shortness of breath, the initial assessment should focus on gathering specific information relevant to the current episode of respiratory distress. A comprehensive health history or full physical examination can be deferred until the acute distress has been addressed. Asking specific questions helps determine the cause of the distress and guides appropriate treatment. While checking for allergies is important, completing the entire admission database is not a priority during the initial assessment. Likewise, delaying the physical assessment for pulmonary function tests is not recommended as the immediate focus should be on addressing the acute respiratory distress before ordering further diagnostic tests or interventions.

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