Nursing Elites

1. What would be the most appropriate follow-up by the home care nurse for a 57-year-old male client with a hemoglobin of 10 g/dl and a hematocrit of 32%?

• A. Ask the client if he has noticed any bleeding or dark stools
• B. Tell the client to call 911 and go to the emergency department immediately
• C. Schedule a repeat Hemoglobin and Hematocrit in 1 month
• D. Tell the client to schedule an appointment with a hematologist

Correct answer: A

Rationale: The correct answer is to ask the client if he has noticed any bleeding or dark stools. Normal hemoglobin for males is 13.0 - 18 g/dl, and normal hematocrit for males is 42 - 52%. The values of hemoglobin and hematocrit provided for the client are below normal, indicating mild anemia. The first step for the nurse is to inquire about any signs of bleeding or changes in stools that could suggest bleeding from the gastrointestinal tract. This helps in assessing the possible cause of the low hemoglobin and hematocrit levels. The other options are not appropriate as calling 911 and going to the emergency department immediately is not warranted for mild anemia, scheduling a repeat test in 1 month delays addressing the current concern, and referring the client to a hematologist may be premature without investigating the cause of the low levels first.

2. A nurse has just started her rounds delivering medication. A new patient on her rounds is a 4-year-old boy who is non-verbal. This child does not have any identification on. What should the nurse do?

• A. Contact the provider
• B. Ask the child to write their name on paper
• C. Ask a coworker about the identification of the child
• D. Ask the father who is in the room the child's name

Correct answer: D

Rationale: When encountering a non-verbal child without identification, it is appropriate for the nurse to ask the accompanying parent or guardian for the child's name. The father, being present in the room, can provide the necessary information. This ensures accurate identification to deliver the correct medication. Contacting the provider may cause unnecessary delays. Asking a non-verbal child to write their name is not feasible. Asking a coworker may not provide reliable identification as they may not have direct knowledge.

3. A mother brings her 26-month-old to the well-child clinic. She expresses frustration and anger due to her child's constant saying 'no' and refusal to follow her directions. The nurse explains this is normal for his age, as negativism is attempting to meet which developmental need?

• A. Trust
• B. Initiative
• C. Independence
• D. Self-esteem

Correct answer: C

Rationale: In Erikson's theory of development, toddlers struggle to assert independence. They often use the word 'no' even when they mean yes. This stage is called autonomy versus shame and doubt. The child's behavior of saying 'no' and resisting directions reflects the developmental need for independence, not trust (option A), initiative (option B), or self-esteem (option D). Trust is typically associated with early infancy, initiative with preschool age, and self-esteem with later childhood and adolescence.

4. How does shock typically progress?

• A. Compensated to hypotensive shock in hours and hypotensive shock to cardiac arrest in minutes
• B. Compensated to hypotensive shock in minutes and hypotensive shock to cardiac arrest in hours
• C. Hypotensive to compensated shock in hours and compensated shock to cardiac arrest in minutes
• D. Hypotensive to compensated shock in minutes and compensated shock to cardiac arrest in hours

Correct answer: A

Rationale: Shock typically progresses from a compensated state to hypotensive shock over a period of hours. In the compensated phase, the body is trying to maintain perfusion. It is crucial to identify and intervene during this phase to prevent progression to hypotensive shock, where blood pressure drops significantly. If not promptly managed, hypotensive shock can rapidly deteriorate into cardiac arrest in minutes due to inadequate perfusion to vital organs. Choices B, C, and D are incorrect as they do not follow the typical progression of shock stages as seen in clinical practice. Understanding the stages of shock and their timeframes is crucial for early recognition and appropriate intervention to prevent further deterioration.

5. A healthcare professional is preparing to palpate and percuss a patient's abdomen as part of the assessment process. Which of these findings would cause the healthcare professional to immediately discontinue this part of the assessment?

• A. The patient states, 'That sounds like it might hurt me.'
• B. There is a pulsating mass on the upper middle abdomen.
• C. The patient has black, tarry stools and anemia.
• D. The patient has had an endoscopic procedure two days prior.

Correct answer: B

Rationale: A pulsating mass on the upper middle abdomen is indicative of a life-threatening aortic aneurysm. Palpating or percussing such an area can potentially cause the aneurysm to rupture, leading to severe internal bleeding and endangering the patient's life. Therefore, the healthcare professional should immediately discontinue the assessment to prevent any harm.\nChoice A is incorrect because the patient expressing concerns about the procedure does not necessarily indicate a life-threatening condition. Choice C describes symptoms that should be further investigated but do not pose an immediate threat during abdominal assessment. Choice D, a prior endoscopic procedure, is not a contraindication for palpation or percussion of the abdomen unless there are specific complications or conditions related to the procedure that would require caution.

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