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. You have accompanied the physician into the family waiting room to tell a young husband that his wife has not survived the car accident she was in. The husband is crying and distraught. What is the most appropriate approach to supporting this family member?

• A. Ask if he would like to donate his wife's organs
• B. Sit quietly with him
• C. Ask about funeral arrangements
• D. Consult social services

Correct answer: B

Rationale: The most caring and supportive approach in a time of extreme distress is usually to sit quietly with the distressed individual until they have had the opportunity to absorb the news and gather themselves. Providing a supportive presence is often the most valuable tool a caregiver can use when circumstances bring overwhelming emotional pain to those they are caring for. Asking about organ donation at this moment may come off as insensitive and should not be a priority. Inquiring about funeral arrangements and consulting social services can be addressed later, once the husband has had time to process the initial shock and emotions.

3. After performing an assessment of an infant with bladder exstrophy, the nurse prepares a plan of care. The nurse identifies which problem as the priority for the infant?

• A. Urinary incontinence
• B. Impaired tissue integrity
• C. Inability to suck and swallow
• D. Lack of knowledge about the disease (parents)

Correct answer: B

Rationale: In bladder exstrophy, the bladder is exposed and external to the body, leading to impaired tissue integrity related to the exposed bladder mucosa as the priority problem. Urinary incontinence is not a concern as the infant is not yet toilet trained. Inability to suck and swallow is unrelated to the disorder. While educating the parents about the condition is important, it is not the priority over addressing the immediate risk of impaired tissue integrity in the infant.

4. A client is being instructed in the use of an incentive spirometer. Which of the following statements from the nurse indicates correct teaching about using this device?

• A. Lie back in a reclining position while using the spirometer.
• B. Take slow deep breaths to reach your goal.
• C. Set a goal of using the spirometer at least 3 times per day.
• D. Practice coughing after taking 10 breaths.

Correct answer: D

Rationale: An incentive spirometer is a device used to improve lung function and reduce the risk of atelectasis. The correct way to use the spirometer is by sitting up and taking slow, deep breaths to achieve the set goal, not by lying back in a reclining position or taking rapid, quick breaths. Setting a goal of using the spirometer multiple times a day is beneficial, but it is not the best indicator of correct teaching. After using the spirometer, the client should practice coughing to help clear any loosened secretions that may have occurred during the breathing exercises.

5. Which response by the nurse best explains the purpose of ranitidine (Zantac) for a patient admitted with bleeding esophageal varices?

• A. The medication will reduce the risk of aspiration.
• B. The medication will inhibit the development of gastric ulcers.
• C. The medication will prevent irritation of the enlarged veins.
• D. The medication will decrease nausea and improve appetite.

Correct answer: C

Rationale: The correct answer is: 'The medication will prevent irritation of the enlarged veins.' Esophageal varices are dilated submucosal veins. The therapeutic action of H2-receptor blockers in patients with esophageal varices is to prevent irritation and bleeding from the varices caused by reflux of acidic gastric contents. While ranitidine can decrease the risk of peptic ulcers, reduce nausea, and help prevent aspiration pneumonia, the primary purpose of H2-receptor blockade in this patient is to prevent irritation and bleeding from the varices, not the other listed effects.

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