Nursing Elites

1. A client is scheduled for a percutaneous transluminal coronary angioplasty (PTCA). The nurse knows that a PTCA is:

• A. Surgical repair of a diseased coronary artery
• B. Placement of an automatic internal cardiac defibrillator
• C. Procedure that compresses plaque against the wall of the diseased coronary artery to improve blood flow
• D. Non-invasive radiographic examination of the heart

Correct answer: C

Rationale: Percutaneous transluminal coronary angioplasty (PTCA) is a procedure that compresses plaque against the wall of the diseased coronary artery to improve blood flow. It is performed during a cardiac catheterization to improve coronary artery blood flow in a diseased artery. Surgical repair of a diseased coronary artery is typically done through procedures like aorto-coronary bypass graft (ACBG) rather than PTCA. Placement of an automatic internal cardiac defibrillator (AICD) is a different procedure used for managing cardiac arrhythmias. Non-invasive radiographic examination of the heart refers to procedures like echocardiography or cardiac MRI, not PTCA.

2. Following surgery to correct cryptorchidism, what is the priority action that the nurse should include in the plan of care?

• A. Prevent tension on the suture.
• B. Monitor urine for glucose and acetone.
• C. Encourage oral fluids, and monitor intake and output.
• D. Encourage coughing and deep breathing every hour.

Correct answer: A

Rationale: The correct answer is to prevent tension on the suture. After surgery for cryptorchidism, the testicle is held in position by an internal suture that should not be dislodged. Immobilization of the area for a week is crucial to prevent complications like bleeding and infection. Monitoring urine for glucose and acetone is unrelated to this surgery. While maintaining hydration is important, forcing fluids is not necessary. Encouraging coughing and deep breathing every hour may be a postoperative consideration, but it is not the priority for this specific surgery.

3. A physician suspects a patient may have pancreatitis. Which of the following tests would be most appropriate to diagnose this condition?

• A. CK and Troponin
• B. BUN and Creatinine
• C. Amylase and Lipase
• D. HDL and LDL Cholesterol Levels

Correct answer: C

Rationale: To diagnose pancreatitis, testing amylase and lipase levels is crucial. Amylase and lipase are enzymes produced by the pancreas that help digest carbohydrates and lipids. In pancreatitis, these enzymes are released in high amounts into the bloodstream due to pancreatic inflammation or damage. Elevated levels of amylase and lipase in blood tests strongly indicate pancreatitis. Choice A, CK and Troponin, are cardiac markers used in diagnosing heart conditions like myocardial infarction, not pancreatitis. Choice B, BUN and Creatinine, are kidney function tests, not specific to pancreatitis. Choice D, HDL and LDL Cholesterol Levels, are lipid profile tests used to assess cardiovascular health, not for diagnosing pancreatitis.

4. The patient's symptoms, lack of antibodies for hepatitis, and the abrupt onset of symptoms suggest toxic hepatitis, which can be caused by commonly used over-the-counter drugs such as acetaminophen (Tylenol). Travel to a foreign country and a history of IV drug use are risk factors for viral hepatitis. Corticosteroid use does not cause the symptoms listed.

• A. Hemoglobin
• B. Temperature
• C. Activity level
• D. Albumin level

Correct answer: D

Rationale: The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in the development of edema. In this case, monitoring the albumin level is crucial to assess the patient's fluid balance and potential for edema. While hemoglobin, temperature, and activity level are important parameters to monitor in a patient's assessment, they are not directly associated with the patient's current symptoms of toxic hepatitis and edema development. Therefore, the correct choice is the albumin level.

5. Application - The nurse is caring for a patient who has the following labs: Creatinine 2.5mg/dL, WBC 11,000 cells/mL, and Hemoglobin of 12 g/dL. Based on this information, which of these orders would the nurse question?

• A. Administer 30 Units of Lantus Daily
• B. CT of the spine with contrast
• C. X-ray of the abdomen and chest
• D. Administer heparin subcutaneously 5,000 Units every 12 hours

Correct answer: B

Rationale: The correct answer is to question the order for a CT of the spine with contrast. The patient's elevated creatinine level of 2.5mg/dL indicates impaired kidney function. Contrast agents are nephrotoxic and can further compromise kidney function in patients with existing nephropathy. Therefore, it is crucial to avoid contrast-enhanced imaging studies in patients with impaired renal function. Choice A: Administering 30 Units of Lantus Daily is not contraindicated based on the provided lab values. Choice C: Ordering an X-ray of the abdomen and chest is not contraindicated based on the provided lab values. Choice D: Administering heparin subcutaneously at 5,000 Units every 12 hours is not contraindicated based on the provided lab values.

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