Nursing Elites

1. The nurse administers prescribed therapies for a patient with cor pulmonale and right-sided heart failure. Which assessment would best evaluate the effectiveness of the therapies?

• A. Observe for distended neck veins.
• B. Auscultate for crackles in the lungs.
• C. Palpate for heaves or thrills over the heart.
• D. Review hemoglobin and hematocrit values.

Correct answer: A

Rationale: To evaluate the effectiveness of therapies for cor pulmonale and right-sided heart failure, observing for distended neck veins would be the most appropriate assessment. Cor pulmonale is characterized by right ventricular failure due to pulmonary hypertension, leading to clinical manifestations such as peripheral edema, jugular venous distention, and right upper-quadrant abdominal tenderness. These signs indicate increased central venous pressure and right heart strain, which can be assessed by observing for distended neck veins. Auscultating for crackles in the lungs is more indicative of left-sided heart failure rather than right-sided heart failure. Heaves or thrills over the heart are not typically associated with cor pulmonale. Reviewing hemoglobin and hematocrit values may show elevations due to chronic hypoxemia and polycythemia in cor pulmonale, but these values alone do not directly evaluate the immediate effectiveness of the prescribed therapies on the patient's condition.

2. The patient is being taught about pulmonary function testing (PFT). Which statement made by the patient indicates effective teaching?

• A. I will use my inhaler right before the test.
• B. I won't eat or drink anything 8 hours before the test.
• C. I should inhale deeply and blow out as hard as I can during the test.
• D. My blood pressure and pulse will be checked every 15 minutes after the test.

Correct answer: C

Rationale: The correct answer is 'I should inhale deeply and blow out as hard as I can during the test.' This statement indicates effective teaching because for PFT, the patient needs to inhale deeply and exhale forcefully. This maneuver helps in assessing lung function accurately. Choices A, B, and D are incorrect. Using an inhaler right before the test may alter the test results, which is not recommended. Fasting for 8 hours is not necessary for a PFT, and checking blood pressure and pulse every 15 minutes after the test is not part of the PFT procedure.

3. In children suspected to have a diagnosis of diabetes, which one of the following complaints would be most likely to prompt parents to take their school-age child for evaluation?

• A. Polyphagia
• B. Dehydration
• C. Bedwetting
• D. Weight loss

Correct answer: C

Rationale: The correct answer is 'Bedwetting.' One of the initial symptoms of type 1 diabetes in children is bedwetting. Parents are likely to notice bedwetting in a school-age child, prompting them to seek evaluation. Polyphagia (excessive hunger) and weight loss are also common symptoms of diabetes but may not be as readily noticeable to parents compared to bedwetting. Dehydration is a consequence of diabetes rather than an early symptom that would prompt parents for evaluation.

4. When reading a lab report, you notice that a patient's sample is described as having anisocytosis. Which of the following most accurately describes the patient's condition?

• A. The patient has an abnormal condition of skin cells.
• B. The patient's red blood cells vary in size.
• C. The patient has a high level of fat cells and is obese.
• D. The patient's cells are indicative of necrosis.

Correct answer: B

Rationale: Anisocytosis is a term that indicates variation in the size of red blood cells. When a patient is described as having anisocytosis, it means their red blood cells exhibit differences in size. This condition can be detected in blood samples and may indicate underlying blood disorders. The other choices are incorrect: Choice A refers to a skin cell condition, Choice C relates to obesity and fat cells, and Choice D suggests necrosis, none of which are associated with anisocytosis or red blood cell abnormalities. It is important to recognize specific terms like anisocytosis in laboratory reports to understand the potential implications for the patient's health.

5. After 2 months of tuberculosis (TB) treatment with isoniazid (INH), rifampin (Rifadin), pyrazinamide (PZA), and ethambutol, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which action should the nurse take next?

• A. Teach about drug-resistant TB treatment
• B. Ask the patient whether medications have been taken as directed
• C. Schedule the patient for directly observed therapy three times weekly
• D. Discuss with the healthcare provider the need for the patient to use an injectable antibiotic

Correct answer: B

Rationale: The first action should be to determine whether the patient has been compliant with drug therapy because negative sputum smears would be expected if the TB bacillus is susceptible to the medications and if the medications have been taken correctly. Assessment is the first step in the nursing process. Depending on whether the patient has been compliant or not, different medications or directly observed therapy may be indicated. The other options are interventions based on assumptions until an assessment has been completed. Teaching about drug-resistant TB treatment (Choice A) is premature without knowing the current medication compliance status. Scheduling directly observed therapy (Choice C) assumes non-compliance without confirming it first. Discussing the need for an injectable antibiotic (Choice D) is premature and not necessarily indicated without assessing the current medication adherence.

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