Nursing Elites

1. The client diagnosed with thalassemia, a hereditary anemia, is to receive a transfusion of packed RBCs. The cross-match reveals the presence of antibodies that cannot be cross-matched. Which precaution should the nurse implement when initiating the transfusion?

• A. Start the transfusion at 10-15 mL per hour for 15-30 minutes
• B. Re-crossmatch the blood until the antibodies are identified
• C. Have the client sign a permit to receive uncrossmatched blood
• D. Have the unlicensed nursing assistant stay with the client

Correct answer: A

Rationale: Starting the transfusion slowly at 10-15 mL per hour for 15-30 minutes is essential when the cross-match reveals the presence of antibodies that cannot be cross-matched. This precaution allows the nurse to monitor for any adverse reactions due to the antibodies. Re-crossmatching the blood until the antibodies are identified (choice B) may delay the transfusion process and put the client at risk. Having the client sign a permit to receive uncrossmatched blood (choice C) is not a standard practice and does not address the immediate need for precautions during transfusion. Having the unlicensed nursing assistant stay with the client (choice D) is unrelated to the safe initiation of the transfusion and is not a precaution specific to managing antibodies in blood products.

2. Which vitamin deficiency is commonly associated with prolonged antibiotic use?

• A. Vitamin A
• B. Vitamin B6
• C. Vitamin C
• D. Vitamin K

Correct answer: D

Rationale: The correct answer is Vitamin K. Prolonged antibiotic use can disrupt the gut flora, leading to Vitamin K deficiency and an increased risk of bleeding. Vitamin A deficiency is not commonly associated with antibiotic use. Similarly, Vitamin B6 and Vitamin C deficiencies are not typically linked to prolonged antibiotic use.

3. A client with a diagnosis of catatonic schizophrenia is expected to exhibit which clinical finding?

• A. Crying
• B. Self-mutilation
• C. Immobile posturing
• D. Repetitious activities

Correct answer: C

Rationale: In catatonic schizophrenia, immobile posturing is a common clinical finding where the patient may maintain a rigid or bizarre posture for prolonged periods. Crying (Choice A) is not typically associated with catatonic schizophrenia. Self-mutilation (Choice B) is more commonly seen in conditions like borderline personality disorder. Repetitious activities (Choice D) are not a hallmark symptom of catatonic schizophrenia.

4. Listed below are five categories that identify the responsibilities of the practical nurse manager in personnel management. Which of these categories is most appropriate for the task 'Ensure that personnel are utilized in their designated roles'?

• A. Accountability
• B. Personal/professional development
• C. Individual training
• D. Military appearance/physical condition

Correct answer: A

Rationale: The correct answer is 'Accountability'. Accountability in personnel management ensures that individuals are utilized in their designated roles, such as ensuring that soldiers are utilized in their Military Occupational Specialty (MOS). This category focuses on ensuring that personnel are assigned and performing their duties as required. The other choices, personal/professional development, individual training, and military appearance/physical condition, do not directly relate to the specific task of ensuring individuals are utilized in their designated roles.

5. The nurse in the pediatric clinic performs a physical assessment of a 13-year-old boy. Which of the following findings by the nurse requires an immediate intervention?

• A. The adolescent complains of his scrotum aching after exercise. The nurse palpates a worm-like mass above the testes
• B. The nurse noted unilateral breast enlargement
• C. The child’s scrotum appears swollen, and a soft mass is palpated. The nurse is unable to insert a finger above the mass
• D. The child’s scrotum appears enlarged and red. The nurse palpated a thickened and swollen spermatic cord.

Correct answer: D

Rationale: A swollen and thickened spermatic cord could indicate testicular torsion, which is a surgical emergency.

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