Nursing Elites

1. A patient in the emergency department complains of back pain and difficulty breathing 15 minutes after a transfusion of packed red blood cells is started. The nurse's first action should be to

• A. administer oxygen therapy at a high flow rate
• B. obtain a urine specimen to send to the laboratory
• C. notify the healthcare provider about the symptoms
• D. disconnect the transfusion and infuse normal saline

Correct answer: D

Rationale: The patient's symptoms, back pain, and difficulty breathing after the transfusion indicate a possible acute hemolytic reaction, a severe transfusion reaction. The priority action in this situation is to discontinue the transfusion immediately to prevent further complications. Infusing normal saline helps maintain the patient's intravascular volume and prevent renal damage. Administering oxygen or obtaining a urine specimen is not the most urgent action and could delay essential treatment. Notifying the healthcare provider is important but should come after ensuring the patient's safety by stopping the blood transfusion.

2. The nurse assesses a patient with pernicious anemia. Which assessment finding would the nurse expect?

• A. Yellow-tinged sclerae
• B. Shiny, smooth tongue
• C. Numbness of the extremities
• D. Gum bleeding and tenderness

Correct answer: C

Rationale: The correct answer is C: Numbness of the extremities. Numbness of the extremities is a common finding in patients with pernicious anemia, which is caused by cobalamin (vitamin B12) deficiency. This deficiency affects the peripheral nervous system, leading to neurological symptoms like numbness and tingling in the extremities. Choices A, B, and D are incorrect: Yellow-tinged sclerae is more indicative of jaundice or liver dysfunction, a shiny smooth tongue is seen in conditions like glossitis, and gum bleeding and tenderness are associated with periodontal disease or vitamin C deficiency, not pernicious anemia.

3. The health care provider orders a liver and spleen scan for a patient who has been in a motor vehicle crash. Which action should the nurse take before this procedure?

• A. Check for any iodine allergy.
• B. Insert a large-bore IV catheter.
• C. Administer prescribed sedatives.
• D. Assist the patient to a flat position.

Correct answer: D

Rationale: Before a liver and spleen scan, it is essential to assist the patient to a flat position. This position helps obtain clear images of the liver and spleen. Checking for iodine allergy (Choice A) is more relevant for procedures involving contrast dye, not a liver and spleen scan. Inserting a large-bore IV catheter (Choice B) may not be necessary for this specific procedure. Administering sedatives (Choice C) is not typically required for a liver and spleen scan, as the patient needs to remain still during the procedure.

4. Which patient requires the most rapid assessment and care by the emergency department nurse?

• A. The patient with hemochromatosis who reports abdominal pain
• B. The patient with neutropenia who has a temperature of 101.8°F
• C. The patient with thrombocytopenia who has oozing gums after a tooth extraction
• D. The patient with sickle cell anemia who has had nausea and diarrhea for 24 hours

Correct answer: B

Rationale: The correct answer is B because a neutropenic patient with a fever is at high risk for developing sepsis. Sepsis can progress rapidly and lead to life-threatening complications. Immediate assessment, obtaining cultures, and initiating antibiotic therapy are essential in this situation. Choices A, C, and D do not present with the same level of urgency as a neutropenic patient with a fever. Abdominal pain in a hemochromatosis patient, oozing gums after a tooth extraction in a thrombocytopenic patient, and nausea and diarrhea in a patient with sickle cell anemia, while concerning, do not indicate the same immediate risk of sepsis as a neutropenic patient with a fever.

5. The nurse is educating a patient who was discharged from the hospital after having cardiac surgery one week ago. The nurse recognizes the patient understands medication management when he/she states:

• A. I need to take my Lisinopril daily to reduce my risk of heart failure
• B. I only need to take the metoprolol when I feel my heart skip a beat
• C. I should carry my nitroglycerin pills in my pocket at all times
• D. I should only take the pain pills when my pain is really bad

Correct answer: A

Rationale: The correct answer is A. Lisinopril is commonly prescribed post-cardiac surgery to manage blood pressure and reduce the risk of heart failure. It is important for the patient to take Lisinopril daily as prescribed to achieve optimal outcomes. Choice B is incorrect as metoprolol is usually prescribed on a regular schedule to manage heart conditions, not just when symptoms occur. Choice C is incorrect because nitroglycerin should be kept in a cool, dry place, not in a pocket where it could be exposed to heat or moisture. Choice D is incorrect as pain medication should be taken as prescribed for adequate pain control, not just when pain is severe.

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