Nursing Elites

1. Which assessment finding should the nurse caring for a patient with thrombocytopenia communicate immediately to the healthcare provider?

• A. The platelet count is 52,000/µL
• B. The patient is difficult to arouse
• C. There are purpura on the oral mucosa
• D. There are large bruises on the patient's back

Correct answer: B

Rationale: The correct answer is B. Difficulty in arousing the patient may indicate a cerebral hemorrhage, which is life-threatening and requires immediate action. While a low platelet count (choice A) is concerning in thrombocytopenia, it does not require immediate communication unless accompanied by active bleeding or other critical symptoms. Purpura on the oral mucosa (choice C) and large bruises on the patient's back (choice D) are important findings in thrombocytopenia but do not indicate an immediate life-threatening situation like a possible cerebral hemorrhage.

2. Which instruction will the nurse plan to include in discharge teaching for a patient admitted with a sickle cell crisis?

• A. Take a daily multivitamin with iron
• B. Limit fluids to 2 to 3 quarts per day
• C. Avoid exposure to crowds when possible
• D. Drink only two caffeinated beverages daily

Correct answer: C

Rationale: The correct answer is C: 'Avoid exposure to crowds when possible.' This instruction is crucial in discharge teaching for a patient admitted with a sickle cell crisis because exposure to crowds increases the risk of infection, which is the most common cause of sickle cell crisis. Choices A, B, and D are incorrect. Taking a daily multivitamin with iron (Choice A) may be beneficial for some individuals but is not specifically related to managing sickle cell crisis. Limiting fluids to 2 to 3 quarts per day (Choice B) is not typically recommended for patients with sickle cell crisis, as adequate hydration is important. Drinking only two caffeinated beverages daily (Choice D) is not a priority instruction in managing sickle cell crisis.

3. A postoperative patient receiving a transfusion of packed red blood cells develops chills, fever, headache, and anxiety 35 minutes after the transfusion is started. After stopping the transfusion, what action should the nurse take?

• A. Give the PRN diphenhydramine
• B. Send a urine specimen to the laboratory
• C. Administer PRN acetaminophen (Tylenol)
• D. Draw blood for a new type and crossmatch

Correct answer: C

Rationale: The patient’s clinical manifestations are consistent with a febrile, nonhemolytic transfusion reaction. The transfusion should be stopped and antipyretics administered for the fever as ordered.

4. 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.

5. The nurse is caring for a patient post coronary artery bypass graft who rates his/her pain as an 8 out of 10 on the subjective pain scale. Should the nurse choose to administer morphine sulfate intravenously as it has benefits to cardiac patients (select one that does not apply)?

• A. Decreasing myocardial oxygen supply
• B. Decreasing myocardial oxygen consumption
• C. Decreasing heart rate
• D. Increasing blood pressure

Correct answer: D

Rationale: Morphine sulfate, a potent opioid analgesic, can cause vasodilation leading to a decrease in blood pressure rather than an increase. Choice A is incorrect as morphine can decrease myocardial oxygen consumption by reducing the workload of the heart. Choice B is incorrect as morphine can decrease heart rate as a side effect. Choice C is incorrect as morphine typically decreases blood pressure rather than increasing it.

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