Nursing Elites

1. A patient is scheduled for a computed tomography (CT) of the chest with contrast media. Which assessment finding should the nurse immediately report to the health care provider?

• A. Patient is claustrophobic.
• B. Patient is allergic to shellfish.
• C. Patient recently used a bronchodilator inhaler.
• D. Patient is not able to remove a wedding band.

Correct answer: B

Rationale: The correct answer is that the patient is allergic to shellfish. This is crucial because the contrast media used in CT scans is iodine-based, and individuals with iodine allergies, such as those allergic to shellfish, are at risk of adverse reactions. It is important to identify and address this allergy to prevent potential complications. The other options do not directly impact the safety or effectiveness of the CT scan with contrast media. Claustrophobia can be managed with patient support, the recent use of a bronchodilator inhaler does not typically affect the CT procedure, and not being able to remove a wedding band is not a critical concern for the scan itself.

2. A child has just been diagnosed with juvenile idiopathic arthritis. Which of the following statements about the disease is most accurate?

• A. The child has a poor chance of recovery without joint deformity.
• B. Most children progress to adult rheumatoid arthritis.
• C. Nonsteroidal anti-inflammatory drugs are the first choice in treatment.
• D. Physical activity should be minimized.

Correct answer: C

Rationale: The correct answer is that nonsteroidal anti-inflammatory drugs are the first choice in treatment for juvenile idiopathic arthritis (formerly known as juvenile rheumatoid arthritis). NSAIDs are important as a first-line treatment and typically require 3-4 weeks for the therapeutic anti-inflammatory effects to be realized. Choice A is incorrect as early treatment can improve outcomes and prevent joint deformities. Choice B is incorrect as juvenile idiopathic arthritis does not necessarily progress to adult rheumatoid arthritis. Choice D is incorrect as physical activity should be encouraged in children with arthritis to maintain joint mobility and overall health.

3. The nurse reviews the record of a newborn infant and notes that a diagnosis of esophageal atresia with tracheoesophageal fistula is suspected. The nurse expects to note which most likely sign of this condition documented in the record?

• A. Incessant crying
• B. Coughing at nighttime
• C. Choking with feedings
• D. Severe projectile vomiting

Correct answer: C

Rationale: In esophageal atresia and tracheoesophageal fistula, the esophagus ends before it reaches the stomach, forming a blind pouch, and there is an abnormal connection (fistula) with the trachea. Any child who exhibits the '3 Cs'"?coughing and choking with feedings and unexplained cyanosis"?should be suspected to have tracheoesophageal fistula. Option A, 'Incessant crying,' is not a typical sign of esophageal atresia with tracheoesophageal fistula. Option B, 'Coughing at nighttime,' is not a specific sign associated with this condition. Option D, 'Severe projectile vomiting,' is not a common sign of esophageal atresia with tracheoesophageal fistula.

4. A patient who has a history of chronic obstructive pulmonary disease (COPD) was hospitalized for increasing shortness of breath and chronic hypoxemia (SaO2 levels of 89% to 90%). In planning for discharge, which action by the nurse will be most effective in improving compliance with discharge teaching?

• A. Start giving the patient discharge teaching on the day of discharge
• B. Have the patient repeat the instructions immediately after teaching
• C. Accomplish the patient teaching just before the scheduled discharge
• D. Arrange for the patient's caregiver to be present during the teaching

Correct answer: D

Rationale: Hypoxemia interferes with the patient's ability to learn and retain information, so having the patient's caregiver present will increase the likelihood that discharge instructions will be followed. Having the patient repeat the instructions will indicate that the information is understood at the time, but it does not guarantee retention of the information. Giving discharge instructions just before discharge is not ideal as the patient is likely to be distracted and anxious at that time. Teaching the patient about discharge on the day of admission is not recommended because the patient may be more hypoxemic and anxious than usual, making it difficult for them to absorb and retain the information effectively. Therefore, arranging for the patient's caregiver to be present during the teaching session is the best option to ensure proper compliance and understanding of the discharge instructions.

5. During an assessment of a client with cardiomyopathy, the nurse finds that the systolic blood pressure has decreased from 145 to 110 mm Hg and the heart rate has risen from 72 to 96 beats per minute, and the client complains of periodic dizzy spells. The nurse instructs the client to:

• A. Increase fluids that are high in protein
• B. Restrict fluids
• C. Force fluids and reassess blood pressure
• D. Limit fluids to non-caffeine beverages

Correct answer: D

Rationale: In this scenario, the client with cardiomyopathy is exhibiting signs of orthostatic hypotension, which is characterized by a significant drop in systolic blood pressure (>15 mm Hg) and an increase in heart rate (>15%), along with dizziness. These symptoms suggest volume depletion, inadequate vasoconstrictor mechanisms, and autonomic insufficiency. The appropriate nursing intervention in this case is to force fluids and reassess blood pressure to address the underlying issue of volume depletion and improve hemodynamic stability. Choices A, B, and D are incorrect because increasing fluids high in protein, restricting fluids, or limiting fluids to non-caffeine beverages are not appropriate actions for a client experiencing orthostatic hypotension and signs of volume depletion.

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