Nursing Elites

1. The nurse recognizes that teaching a 44-year-old woman following a laparoscopic cholecystectomy has been effective when the patient states which of the following?

• A. I can expect yellow-green drainage from the incision for a few days.
• B. I can remove the bandages on my incisions tomorrow and take a shower.
• C. I should plan to limit my activities and not return to work for 4 to 6 weeks.
• D. I will always need to maintain a low-fat diet since I no longer have a gallbladder.

Correct answer: B

Rationale: The correct answer is, 'I can remove the bandages on my incisions tomorrow and take a shower.' After a laparoscopic cholecystectomy, patients have Band-Aids over the incisions and can typically remove the bandages the next day. Patients are usually discharged the same or next day and have minimal restrictions on their daily activities. Yellow-green drainage from the incision would be abnormal, requiring the patient to contact their healthcare provider. While a low-fat diet may be recommended initially after surgery, it is not a lifelong requirement, as the body can adjust to the absence of the gallbladder over time. Choice A is incorrect as abnormal drainage should be reported. Choice C is incorrect as most patients can resume normal activities within a few days to a week. Choice D is incorrect as maintaining a low-fat diet is not a lifelong necessity after a cholecystectomy.

2. A healthcare professional is putting together a presentation on meningitis. Which of the following microorganisms has not been linked to meningitis in humans?

• A. S. pneumoniae
• B. H. influenzae
• C. N. meningitidis
• D. Cl. difficile

Correct answer: D

Rationale: The correct answer is Cl. difficile. Clostridium difficile (C. diff) is not typically associated with meningitis in humans. This bacterium is known to cause severe diarrhea, usually as a result of antibiotic treatment. S. pneumoniae, H. influenzae, and N. meningitidis are all known to be causative agents of meningitis in humans. S. pneumoniae is a common cause of bacterial meningitis, especially in adults. H. influenzae, particularly type b (Hib), used to be a leading cause of meningitis in children before the introduction of the Hib vaccine. N. meningitidis is another significant pathogen responsible for causing meningitis, especially in young adults and adolescents.

3. Following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of ineffective airway clearance. Which assessment data best supports this diagnosis?

• A. Weak, nonproductive cough effort
• B. Large amounts of greenish sputum
• C. Respiratory rate of 28 breaths/minute
• D. Resting pulse oximetry (SpO2) of 85%

Correct answer: A

Rationale: The correct answer is 'Weak, nonproductive cough effort.' A weak, nonproductive cough indicates that the patient is unable to clear the airway effectively, supporting the nursing diagnosis of ineffective airway clearance. In pneumonia, secretions can obstruct the airway, leading to ineffective clearance. Choices B, C, and D do not directly reflect ineffective airway clearance. Large amounts of greenish sputum (Choice B) may suggest infection or inflammation but do not specifically indicate ineffective airway clearance. The respiratory rate of 28 breaths/minute (Choice C) and a resting pulse oximetry (SpO2) of 85% (Choice D) are more indicative of impaired gas exchange or respiratory distress rather than ineffective airway clearance.

4. When orally administering alendronate (Fosamax), a bisphosphonate drug, to a largely bed-bound patient being treated for osteoporosis, what is the most important nursing consideration?

• A. Sit the head of the bed up for 30 minutes after administration
• B. Give the patient a small amount of water to drink
• C. Feed the patient soon, at most 10 minutes after administration
• D. Assess the patient for back pain or abdominal pain

Correct answer: A

Rationale: The correct nursing consideration when administering bisphosphonates like alendronate is to sit the head of the bed up for 30 minutes after administration. Bisphosphonates are known to cause esophageal irritation, which can lead to esophagitis. By sitting upright, the patient reduces the time the medication spends in the esophagus, decreasing the risk of irritation and potential adverse effects. Giving the patient water to drink or feeding them immediately after administration can increase the risk of esophageal irritation. Assessing the patient for back pain or abdominal pain is important but not the most critical consideration during drug administration.

5. A patient with bacterial pneumonia has rhonchi and thick sputum. What is the nurse's most appropriate action to promote airway clearance?

• A. Assist the patient to splint the chest when coughing.
• B. Teach the patient about the need for fluid intake.
• C. Encourage the patient to wear the nasal oxygen cannula.
• D. Instruct the patient on the pursed lip breathing technique.

Correct answer: A

Rationale: Assisting the patient to splint the chest when coughing is the most appropriate action to promote airway clearance in a patient with bacterial pneumonia, rhonchi, and thick sputum. Splinting the chest helps reduce pain during coughing and increases the effectiveness of clearing secretions. Teaching the patient about the need for fluid intake is important as it helps liquefy secretions, aiding in easier clearance. Encouraging the patient to wear a nasal oxygen cannula may improve gas exchange but does not directly promote airway clearance. Instructing the patient on the pursed lip breathing technique is beneficial for improving gas exchange in patients with COPD but does not directly aid in airway clearance in a patient with bacterial pneumonia and thick sputum.

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