Nursing Elites

1. The nurse is caring for a patient in the cardiac unit recovering from a cardiac bypass graft procedure. The patient's spouse comes out to the hallway and expresses concern about the patient's confusion since surgery was 3 days ago. An appropriate response by the nurse would be:

• A. Let me call the doctor right away.
• B. What specific concerns do you have?
• C. It is common for confusion to occur after this procedure.
• D. I'll have the counselor come meet you in the room.

Correct answer: C

Rationale: Choice C is the correct answer because confusion can be a common occurrence after cardiac surgeries due to factors such as anesthesia, medication, and the stress of the procedure. By acknowledging the spouse's concern and explaining that confusion is a known potential outcome, the nurse provides reassurance and education. Choices A, B, and D are incorrect because they do not directly address the spouse's concern about the patient's confusion or provide appropriate information about the situation.

2. A patient who is receiving methotrexate for severe rheumatoid arthritis develops a megaloblastic anemia. The nurse will anticipate teaching the patient about increasing oral intake of

• A. iron.
• B. folic acid.
• C. cobalamin (vitamin B12).
• D. ascorbic acid (vitamin C).

Correct answer: C

Rationale: The correct answer is C: cobalamin (vitamin B12). Methotrexate can lead to a deficiency in cobalamin, resulting in megaloblastic anemia. Therefore, increasing the oral intake of cobalamin is essential to address this deficiency. Choice A, iron, is incorrect because megaloblastic anemia caused by methotrexate is not typically due to iron deficiency. Choice B, folic acid, is also incorrect as methotrexate does not directly cause folic acid deficiency. Choice D, ascorbic acid (vitamin C), is incorrect as it is not directly related to megaloblastic anemia caused by methotrexate; instead, cobalamin is the key vitamin that needs attention.

3. A patient with immune thrombocytopenic purpura (ITP) has an order for a platelet transfusion. Which information indicates that the nurse should consult with the healthcare provider before obtaining and administering platelets?

• A. Platelet count is 42,000/µL
• B. Petechiae are present on the chest
• C. Blood pressure (BP) is 94/56 mm Hg
• D. Blood is oozing from the venipuncture site

Correct answer: A

Rationale: The correct answer is A. Platelet transfusions are not usually indicated until the platelet count is below 10,000 to 20,000/µL unless the patient is actively bleeding. In this case, with a platelet count of 42,000/µL, the count is not critically low, and the patient is not actively bleeding. Therefore, the nurse should consult with the healthcare provider before giving the transfusion. Choices B, C, and D are incorrect because the presence of petechiae, low blood pressure, and oozing from the venipuncture site are common findings in patients with ITP and do not necessarily require immediate consultation before administering a platelet transfusion.

4. The nurse is reviewing laboratory results and notes a patient's activated partial thromboplastin time (aPTT) level of 28 seconds. The nurse should notify the health care provider in anticipation of adjusting which medication?

• A. Aspirin
• B. Heparin
• C. Warfarin
• D. Erythropoietin

Correct answer: B

Rationale: The correct answer is B: Heparin. An activated partial thromboplastin time (aPTT) level of 28 seconds indicates a prolonged time, which is associated with heparin administration. Heparin is an anticoagulant medication that affects the intrinsic pathway of the coagulation cascade, leading to an increased aPTT. Aspirin (choice A) affects platelet aggregation and does not directly impact aPTT. Warfarin (choice C) affects the extrinsic pathway of the coagulation cascade and is monitored using the international normalized ratio (INR), not aPTT. Erythropoietin (choice D) is not related to coagulation parameters.

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.

Similar Questions