Nursing Elites

1. Which collaborative problem will the nurse include in a care plan for a patient admitted to the hospital with idiopathic aplastic anemia?

• A. Potential complication: seizures
• B. Potential complication: infection
• C. Potential complication: neurogenic shock
• D. Potential complication: pulmonary edema

Correct answer: B

Rationale: The correct answer is B: Potential complication: infection. Patients with idiopathic aplastic anemia have pancytopenia, which puts them at a high risk for infections due to decreased production of all blood cells (red blood cells, white blood cells, and platelets). Infection is a significant concern in these patients. Choices A, C, and D are incorrect because seizures, neurogenic shock, and pulmonary edema are not typically associated with idiopathic aplastic anemia. While seizures can occur in some conditions that affect the brain, neurogenic shock is related to spinal cord injury, and pulmonary edema is more commonly seen in conditions like heart failure.

2. 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.

3. Which task for a patient with neutropenia is appropriate for the registered nurse (RN) to delegate to a licensed practical/vocational nurse (LPN/LVN)?

• A. Assessing the patient for signs and symptoms of infection
• B. Teaching the patient the purpose of neutropenic precautions
• C. Administering subcutaneous filgrastim (Neupogen) injection
• D. Developing a discharge teaching plan for the patient and family

Correct answer: C

Rationale: The correct answer is C because administering subcutaneous medications falls within the education and scope of practice of an LPN/LVN. Assessing the patient for signs and symptoms of infection, teaching the patient, and developing a discharge plan are tasks that require an RN level of education and scope of practice. LPN/LVNs can assist in patient care, but tasks that involve assessment, teaching, and care planning are typically the responsibility of an RN.

4. Which statement by a patient indicates good understanding of the nurse’s teaching about prevention of sickle cell crisis?

• A. Home oxygen therapy is frequently used to decrease sickling.
• B. There are no effective medications that can help prevent sickling.
• C. Routine continuous dosage narcotics are prescribed to prevent a crisis.
• D. Risk for a crisis is decreased by having an annual influenza vaccination.

Correct answer: D

Rationale: Because infection is the most common cause of a sickle cell crisis, influenza, Haemophilus influenzae, pneumococcal pneumonia, and hepatitis immunizations should be administered.

5. 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.

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