Nursing Elites

1. You are caring for Thomas N., a 77-year-old man with edema in his legs and a fluid restriction. You have been assigned to weigh him daily. Based on these symptoms and the care he is receiving, what disorder is he most likely affected by?

• A. Diabetes
• B. Dementia
• C. Congestive heart failure
• D. Contiguous heart disease

Correct answer: C

Rationale: Thomas N.'s symptoms of edema in his legs and fluid restriction point towards congestive heart failure (CHF) rather than dementia or diabetes. In CHF, patients often present with dependent edema in their legs due to excessive blood volume, leading to fluid intake restrictions and a low-salt diet. Daily weight monitoring is crucial in CHF to assess fluid retention or loss. Diabetes primarily affects blood sugar levels, dementia is a cognitive disorder, and 'Contiguous heart disease' is not a recognized medical term, making choices A, B, and D incorrect in this scenario.

2. A patient is admitted to the same-day surgery unit for a liver biopsy. Which of the following laboratory tests assesses coagulation? Select one that doesn't apply.

• A. Partial thromboplastin time
• B. Prothrombin time
• C. Platelet count
• D. Hemoglobin

Correct answer: D

Rationale: The correct answer is 'Hemoglobin.' Hemoglobin levels are not indicative of coagulation status but are important for assessing oxygen-carrying capacity. Choices A, B, and C are all laboratory tests that assess coagulation. Partial thromboplastin time (PTT) and prothrombin time (PT) evaluate different aspects of the coagulation cascade, while platelet count is essential for assessing primary hemostasis. Therefore, in the context of evaluating coagulation, hemoglobin is not the appropriate choice.

3. A victim of domestic violence states, 'If I were better, I would not have been beaten.' Which feeling best describes what the victim may be experiencing?

• A. Fear
• B. Helplessness
• C. Self-blame
• D. Rejection

Correct answer: C

Rationale: The correct answer is self-blame. In this scenario, the victim is attributing the abuse to their own inadequacies or faults, thinking that if they were different, the abuse would not occur. This is a common response seen in victims of domestic violence, where they wrongly internalize the blame for the abuser's actions. Fear (Choice A) is a valid emotion, but in this case, the victim is not expressing fear but rather self-blame. Helplessness (Choice B) is also a common feeling in victims of domestic violence, but in this specific statement, the victim is demonstrating self-blame. Rejection (Choice D) does not accurately reflect the victim's statement and emotional response in the given scenario.

4. A home health nurse is at the home of a client with diabetes and arthritis. The client has difficulty drawing up insulin. It would be most appropriate for the nurse to refer the client to

• A. A social worker from the local hospital
• B. An occupational therapist from the community center
• C. A physical therapist from the rehabilitation agency
• D. Another client with diabetes mellitus who takes insulin

Correct answer: B

Rationale: An occupational therapist from the community center would be the most appropriate referral for this client. Occupational therapists specialize in helping individuals improve fine motor skills, which are essential for tasks like drawing up insulin injections. A social worker typically focuses on psychosocial aspects, a physical therapist on physical mobility, and another client with diabetes would not have the professional expertise to address the client's specific needs related to insulin preparation.

5. A man is receiving heparin subcutaneously. The patient has dementia and lives at home with a part-time caretaker. The nurse is most concerned about which side effect of heparin?

• A. Back Pain
• B. Fever and Chills
• C. Risk for Bleeding
• D. Dizziness

Correct answer: C

Rationale: The correct answer is 'Risk for Bleeding.' A patient with dementia may have impaired judgment and may be prone to falls or injuries, increasing the risk of bleeding while on heparin therapy. Monitoring for signs of bleeding is crucial in this situation. Choice A, 'Back Pain,' is not a common side effect of heparin. Choice B, 'Fever and Chills,' is not a typical side effect of heparin but may indicate other underlying conditions. Choice D, 'Dizziness,' is not a common side effect of heparin and is not the primary concern in this scenario.

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