Nursing Elites

1. Several patients call the outpatient clinic and ask to make an appointment as soon as possible. Which patient should the nurse schedule to be seen first?

• A. A 44-year-old with sickle cell anemia who reports his eyes always look somewhat yellow
• B. A 23-year-old with no previous health problems who has a nontender lump in the axilla
• C. A 50-year-old with early-stage chronic lymphocytic leukemia who reports chronic fatigue
• D. A 19-year-old with hemophilia who wants to learn to self-administer factor VII replacement

Correct answer: B

Rationale: The patient's young age and the presence of a nontender lump in the axilla raise concerns for possible lymphoma, which requires prompt evaluation and treatment. This patient should be seen first to rule out any serious underlying condition. Choice A is less urgent as yellowish eyes in sickle cell anemia may be due to jaundice but not necessarily an acute issue. Choice C, a 50-year-old with chronic fatigue related to early-stage chronic lymphocytic leukemia, is a known condition that can be managed on a routine basis. Choice D, a 19-year-old with hemophilia wanting to self-administer factor VII replacement, is important but less urgent compared to the potential lymphoma presentation in choice B.

2. A 62-year-old man with chronic anemia is experiencing increased fatigue and occasional palpitations at rest. The nurse would expect the patient's laboratory test findings to include

• A. an RBC count of 4,500,000/μL.
• B. a hematocrit (Hct) value of 38%.
• C. normal red blood cell (RBC) indices.
• D. a hemoglobin (Hgb) of 8.6 g/dL.

Correct answer: B

Rationale: The correct answer is B. In chronic anemia, the hematocrit (Hct) value is a crucial indicator of the proportion of red blood cells in the blood. A hematocrit value of 38% indicates a lower than normal level of red blood cells, which aligns with the patient's symptoms of fatigue and palpitations. Choices A, C, and D are incorrect because a low RBC count, normal RBC indices, and a hemoglobin level of 8.6 g/dL do not specifically address the decreased red blood cell mass associated with chronic anemia.

3. The health care provider's progress note for a patient states that the complete blood count (CBC) shows a 'shift to the left.' Which assessment finding will the nurse expect?

• A. Cool extremities
• B. Pallor and weakness
• C. Elevated temperature
• D. Low oxygen saturation

Correct answer: C

Rationale: The correct answer is C: Elevated temperature. When a CBC shows a 'shift to the left,' it indicates elevated levels of immature polymorphonuclear neutrophils (bands), which is a sign of infection. In response to the infection, the body increases its temperature as part of the immune response. Choices A, B, and D are incorrect because cool extremities, pallor and weakness, and low oxygen saturation are not typically associated with a 'shift to the left' in a CBC; they are more indicative of other conditions or issues.

4. 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.

5. The complete blood count (CBC) indicates that a patient is thrombocytopenic. Which action should the nurse include in the plan of care?

• A. Avoid intramuscular injections.
• B. Encourage increased oral fluids.
• C. Check temperature every 4 hours.
• D. Increase intake of iron-rich foods.

Correct answer: A

Rationale: The correct action to include in the plan of care for a thrombocytopenic patient is to avoid intramuscular injections. Thrombocytopenia is a condition characterized by a decreased number of platelets, which are essential for blood clotting. Intramuscular injections can pose a risk of bleeding in patients with low platelet counts. Encouraging increased oral fluids (choice B) is beneficial for hydration but does not directly address the risk of bleeding associated with thrombocytopenia. Checking temperature every 4 hours (choice C) is important for monitoring infection but does not specifically address the risk of bleeding. Increasing intake of iron-rich foods (choice D) is more related to addressing anemia, not the primary concern of bleeding in thrombocytopenia.

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