Nursing Elites

1. An older patient is receiving standard multidrug therapy for tuberculosis (TB). The nurse should notify the health care provider if the patient exhibits which finding?

• A. Yellow-tinged skin
• B. Orange-colored sputum
• C. Thickening of the fingernails
• D. Difficulty hearing high-pitched voices

Correct answer: A

Rationale: The correct answer is 'Yellow-tinged skin.' Yellow-tinged skin is indicative of noninfectious hepatitis, a toxic effect of isoniazid (INH), rifampin, and pyrazinamide. If a patient on TB therapy develops hepatotoxicity, alternative medications will be necessary. Thickening of fingernails and difficulty hearing high-pitched voices are not typical side effects of the medications used in standard TB therapy. Presbycusis, age-related hearing loss, is common in older adults and not a cause for immediate concern. Orange-colored sputum is an expected side effect of rifampin and does not warrant immediate notification to the healthcare provider.

2. A patient in metabolic alkalosis is admitted to the emergency department, and pulse oximetry indicates that the O2 saturation is 94%. Which action should the nurse take next?

• A. Administer bicarbonate.
• B. Complete a head-to-toe assessment.
• C. Place the patient on high-flow oxygen.
• D. Obtain repeat arterial blood gases (ABGs).

Correct answer: C

Rationale: In a patient with metabolic alkalosis and an O2 saturation of 94%, placing the patient on high-flow oxygen is the correct action. Even though the O2 saturation seems adequate, metabolic alkalosis causes a left shift in the oxyhemoglobin dissociation curve, reducing oxygen delivery to tissues. Therefore, providing high-flow oxygen can help compensate for this. Administering bicarbonate would exacerbate the alkalosis. While completing a head-to-toe assessment and obtaining repeat ABGs are important interventions, the priority in this scenario is to improve oxygen delivery by placing the patient on high-flow oxygen.

3. In which order should the nurse take the following actions for an older patient with new onset confusion who is normally alert and oriented?

• A. Obtain the oxygen saturation, Check the patient's pulse rate, Notify the health care provider, Document the change in status
• B. Obtain the oxygen saturation, Check the patient's pulse rate, Document the change in status, Notify the health care provider
• C. Document the change in status, Notify the health care provider, Check the patient's pulse rate, Obtain the oxygen saturation
• D. Document the change in status, Check the patient's pulse rate, Obtain the oxygen saturation, Notify the health care provider

Correct answer: B

Rationale: The correct order of actions for the nurse in this scenario is to first obtain the oxygen saturation to assess the patient's airway and oxygenation status. Next, checking the patient's pulse rate helps in evaluating circulation. Subsequently, documenting the change in the patient's status is important for maintaining an accurate record of care. Finally, notifying the health care provider is crucial to ensure timely intervention and further management. Choices A, C, and D are incorrect because assessing oxygen saturation should precede checking the pulse rate to address potential physiological causes of confusion. Additionally, documentation should follow patient assessment and notification of the healthcare provider for appropriate record-keeping and communication.

4. A 7-year-old child is seen in a clinic, and the pediatrician documents a diagnosis of nighttime (nocturnal) enuresis. What information should the nurse provide to the parents?

• A. Nighttime (nocturnal) enuresis does not respond to treatment.
• B. Nighttime (nocturnal) enuresis is caused by a psychiatric problem.
• C. Nighttime (nocturnal) enuresis requires surgical intervention to improve the problem.
• D. Nighttime (nocturnal) enuresis is usually outgrown without therapeutic intervention.

Correct answer: D

Rationale: Nighttime (nocturnal) enuresis is common in children and is characterized by a child who has never been dry at night for extended periods. Most children eventually outgrow bedwetting without therapeutic intervention. This condition is due to the child being unable to sense a full bladder and not awakening to void, often related to delayed maturation of the central nervous system. It is important for parents to understand that nighttime (nocturnal) enuresis is not caused by a psychiatric problem, does not typically require surgical intervention, and usually resolves on its own over time.

5. A patient is on bedrest 24 hours after a hip fracture. Which regular assessment or intervention is essential for detecting or preventing the complication of Fat Embolism Syndrome?

• A. Performing passive, light range-of-motion exercises on the hip as tolerated.
• B. Assess the patient's mental status for drowsiness or sleepiness.
• C. Assess the pedal pulse and capillary refill in the toes.
• D. Administer a stool softener as ordered.

Correct answer: B

Rationale: In detecting or preventing Fat Embolism Syndrome (FES), assessing the patient's mental status for drowsiness or sleepiness is crucial. Decreased level of consciousness is an early sign of FES due to decreased oxygen levels. Performing passive, light range-of-motion exercises on the hip may not directly relate to FES. Assessing pedal pulse and capillary refill in the toes is essential for assessing circulation but not specific to detecting FES. Administering a stool softener, while important for preventing constipation in immobilized patients, is not directly related to detecting or preventing FES.

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