Nursing Elites

1. A female patient with atrial fibrillation has the following lab results: Hemoglobin of 11 g/dl, a platelet count of 150,000, an INR of 2.5, and potassium of 2.7 mEq/L. Which result is critical and should be reported to the physician immediately?

• A. Hemoglobin of 11 g/dl
• B. Platelet count of 150,000
• C. INR of 2.5
• D. Potassium of 2.7 mEq/L

Correct answer: D

Rationale: The critical lab result that should be reported to the physician immediately in this case is the potassium level of 2.7 mEq/L. A potassium imbalance, especially in a patient with a history of dysrhythmia like atrial fibrillation, can be life-threatening and lead to cardiac distress. Low potassium levels (hypokalemia) can predispose the patient to dangerous arrhythmias, including worsening atrial fibrillation. Hemoglobin of 11 g/dl, platelet count of 150,000, and an INR of 2.5 are within acceptable ranges and not as immediately concerning as a low potassium level in this clinical context.

2. A patient is on bedrest 24 hours after a hip fracture. Which regular assessment or intervention is essential for detecting or preventing the complication of Fat Embolism Syndrome?

• A. Performing passive, light range-of-motion exercises on the hip as tolerated.
• B. Assess the patient's mental status for drowsiness or sleepiness.
• C. Assess the pedal pulse and capillary refill in the toes.
• D. Administer a stool softener as ordered.

Correct answer: B

Rationale: In detecting or preventing Fat Embolism Syndrome (FES), assessing the patient's mental status for drowsiness or sleepiness is crucial. Decreased level of consciousness is an early sign of FES due to decreased oxygen levels. Performing passive, light range-of-motion exercises on the hip may not directly relate to FES. Assessing pedal pulse and capillary refill in the toes is essential for assessing circulation but not specific to detecting FES. Administering a stool softener, while important for preventing constipation in immobilized patients, is not directly related to detecting or preventing FES.

3. A patient is admitted with active tuberculosis (TB). The nurse should question a healthcare provider's order to discontinue airborne precautions unless which assessment finding is documented?

• A. Chest x-ray shows no upper lobe infiltrates.
• B. TB medications have been taken for 6 months.
• C. Mantoux testing shows an induration of 10 mm.
• D. Three sputum smears for acid-fast bacilli are negative.

Correct answer: D

Rationale: The correct answer is D: Three sputum smears for acid-fast bacilli are negative. Negative sputum smears indicate that Mycobacterium tuberculosis is not present in the sputum, and the patient cannot transmit the bacteria by the airborne route. This finding is crucial for discontinuing airborne precautions. Choice A is incorrect because chest x-rays do not determine the presence of active TB for transmission precautions. Choice B is not directly related to the infectiousness of TB; completing a 6-month course of medication is important for treatment but does not confirm the absence of active disease or infectiousness. Choice C is not relevant to assessing infectiousness; Mantoux testing measures exposure to TB but does not confirm the absence of active infection or infectiousness.

4. A female patient is prescribed metformin for glucose control. The patient is on NPO status pending a diagnostic test. The nurse is most concerned about which side effect of metformin?

• A. Diarrhea and Vomiting
• B. Dizziness and Drowsiness
• C. Metallic taste
• D. Hypoglycemia

Correct answer: D

Rationale: The correct answer is 'Hypoglycemia.' When a patient is on NPO status (nothing by mouth) and prescribed metformin, there is an increased risk of hypoglycemia due to the absence of oral intake. Metformin, as an anti-glycemic drug, can lower blood sugar levels, and without food intake, the risk of hypoglycemia is higher. Diarrhea and vomiting are common gastrointestinal side effects of metformin but are not the main concern in this scenario. Dizziness and drowsiness are potential side effects of some medications but are not typically associated with metformin. Metallic taste is a known side effect of metformin but is not the primary concern in this situation where hypoglycemia is more critical to monitor due to the patient's NPO status.

5. Which assessment finding would the nurse need to report most quickly to the health care provider regarding a patient with acute pancreatitis?

• A. Nausea and vomiting
• B. Hypotonic bowel sounds
• C. Abdominal tenderness and guarding
• D. Muscle twitching and finger numbness

Correct answer: D

Rationale: The correct answer is muscle twitching and finger numbness. These symptoms indicate hypocalcemia, which can lead to tetany if not promptly addressed with calcium gluconate administration. Nausea and vomiting, hypotonic bowel sounds, and abdominal tenderness and guarding are important findings in acute pancreatitis but do not require the same urgent intervention as hypocalcemia to prevent potential severe complications.

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