Nursing Elites

1. After a client has a tubal ligation in the outpatient surgical clinic, what is the priority for the nurse to determine?

• A. The client's prior experiences with outpatient surgery
• B. The client's medical plan and the extent of coverage for outpatient surgery
• C. The client's plan for transportation and care at home
• D. The client's plan to spend the night at the surgical center

Correct answer: C

Rationale: The priority for the nurse is to ensure the client has a safe way to get home and adequate care after discharge. It is crucial to determine the client's transportation arrangements and availability of care at home to ensure a smooth transition postoperatively. Options A and B, though important, are not immediate priorities compared to the client's safety and well-being after the procedure. Option D is incorrect as spending the night at the surgical center is not typically part of the plan for outpatient surgery.

2. A healthcare professional is screening patients for immunizations. Which of the following is not a contraindication for immunization?

• A. Seizures
• B. Fever lasting more than 3 days
• C. Malignancy within the past 3 months
• D. Illness lasting more than 6 months

Correct answer: D

Rationale: The correct answer is D, 'Illness lasting more than 6 months.' Chronic conditions lasting more than 6 months are not considered a contraindication for immunization. Choice A, 'Seizures,' can be a contraindication in certain situations, especially if linked to a specific vaccine component. Choice B, 'Fever lasting more than 3 days,' can be a temporary precaution but not a general contraindication. Choice C, 'Malignancy within the past 3 months,' is a contraindication due to the compromised immune system in cancer patients.

3. In Parkinson's disease, a client's difficulty in performing voluntary movements is known as:

• A. Akinesia.
• B. Dyskinesia.
• C. Chorea.
• D. Dystonia.

Correct answer: C.

Rationale: In Parkinson's disease, the client's difficulty in performing voluntary movements is termed dyskinesia. Dyskinesia refers to the impairment of the ability to execute voluntary muscle movements. Akinesia, on the other hand, refers to the absence or lack of voluntary movement. Chorea is characterized by involuntary, rapid, irregular movements. Dystonia involves sustained muscle contractions resulting in abnormal postures or twisting movements. Therefore, dyskinesia is the specific term used for the described difficulty in Parkinson's disease.

4. The anemias most often associated with pregnancy are:

• A. folic acid and iron deficiency.
• B. folic acid deficiency and thalassemia.
• C. iron deficiency and thalassemia.
• D. thalassemia and B12 deficiency.

Correct answer: B

Rationale: Folic acid and iron deficiency anemia are the most common types of anemia associated with pregnancy. Approximately 50% of pregnant women experience this type of anemia. Iron deficiency anemia during pregnancy typically results from the increased plasma volume, rather than a decrease in iron levels. Moreover, if a woman has iron deficiency anemia before pregnancy, it often worsens during pregnancy. Folic acid deficiency is also prevalent during pregnancy due to the increased demand for this nutrient to support fetal development. Thalassemia and B12 deficiency, while types of anemia, are not as commonly associated with pregnancy compared to folic acid and iron deficiency anemia, making them incorrect choices in this context.

5. A client has been diagnosed with Disseminated Intravascular Coagulation (DIC) and transferred to the medical intensive care unit (ICU) following an acute bleeding episode. In the ICU, continuous Heparin drip therapy is initiated. Which of the following assessment findings indicates a positive response to Heparin therapy?

• A. increased platelet count
• B. increased fibrinogen
• C. decreased fibrin split products
• D. decreased bleeding

Correct answer: B

Rationale: In the context of DIC, effective Heparin therapy aims to halt the process of intravascular coagulation. One of the indicators of a positive response to Heparin therapy is an increase in fibrinogen levels. Heparin interferes with the conversion of fibrinogen to fibrin by thrombin. This interruption helps increase the availability of fibrinogen. While the platelet count may increase due to improved clotting, the primary focus of Heparin therapy is on fibrinogen. Fibrin split products are expected to decrease as the coagulation cascade is controlled. Although decreased bleeding is an ultimate goal, the immediate effect of Heparin is not directly on bleeding but on the coagulation process.

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