Nursing Elites

1. The parents of a 2-year-old child who had an orchiopexy to correct cryptorchidism are provided with discharge instructions by the nurse. Which statement by the parents indicates the need for further instruction?

• A. I'll check his temperature.
• B. I'll give him medication so he'll be comfortable.
• C. I'll check his voiding to be sure there's no problem.
• D. I'll let him decide when to return to his play activities.

Correct answer: D

Rationale: Cryptorchidism is a condition where one or both testes fail to descend into the scrotal sac. Orchiopexy, a surgical correction, may be required. After surgery, it is crucial to restrict vigorous activities for 2 weeks to promote healing and prevent injury. Allowing the child to decide when to return to play activities may lead to delayed healing and increased risk of injury, as 2-year-olds typically want to be active. Checking the child's temperature, administering analgesics as needed, and monitoring urine output are important postoperative care measures to ensure recovery and detect complications early. Therefore, the statement indicating the need for further instruction is the one related to letting the child decide when to resume play activities.

2. Which topic is most important to include in patient teaching for a 41-year-old patient diagnosed with early alcoholic cirrhosis?

• A. Maintaining good nutrition
• B. Avoiding alcohol ingestion
• C. Taking lactulose (Cephulac)
• D. Using vitamin B supplements

Correct answer: B

Rationale: The most important topic to include in patient teaching for a 41-year-old patient diagnosed with early alcoholic cirrhosis is avoiding alcohol ingestion. Alcohol abstinence is crucial in stopping or reversing the progression of the disease. While maintaining good nutrition, taking lactulose (Cephulac), and using vitamin B supplements are important interventions in managing cirrhosis, abstaining from alcohol is the priority for this patient to prevent further damage to the liver and halt disease progression.

3. When taking the blood pressure (BP) on the right arm of a patient with severe acute pancreatitis, the nurse notices carpal spasms of the patient's right hand. Which action should the nurse take next?

• A. Ask the patient about any arm pain.
• B. Retake the patient's blood pressure.
• C. Check the calcium level in the chart.
• D. Notify the healthcare provider immediately.

Correct answer: C

Rationale: In this scenario, the nurse observed carpal spasms in the patient's right hand, indicating a positive Trousseau's sign, which is associated with hypocalcemia. Patients with acute pancreatitis are at risk for hypocalcemia, hence the nurse should promptly check the calcium level in the chart to assess the patient's condition. Notifying the healthcare provider comes after confirming the calcium level. There is no indication to ask about arm pain or to retake the blood pressure, as the primary concern is addressing the potential hypocalcemia.

4. A patient is admitted to the emergency department complaining of sudden onset shortness of breath and is diagnosed with a possible pulmonary embolus. How should the nurse prepare the patient for diagnostic testing to confirm the diagnosis?

• A. Start an IV so contrast media may be given
• B. Ensure that the patient has been NPO for at least 6 hours.
• C. Inform radiology that a radioactive glucose preparation is needed
• D. Instruct the patient to undress to the waist and remove any metal objects

Correct answer: A

Rationale: For diagnosing pulmonary emboli, spiral computed tomography (CT) scans are commonly used, and contrast media may be given intravenously (IV) during the scan to enhance visualization of blood vessels. Chest x-rays are not typically diagnostic for pulmonary embolism. When preparing for a chest x-ray, the patient needs to undress and remove any metal objects. Bronchoscopy is used for examining the bronchial tree, not for assessing vascular changes, and the patient should be NPO 6 to 12 hours before the procedure. Positron emission tomography (PET) scans are primarily used to detect malignancies, and a radioactive glucose preparation is utilized for this purpose.

5. Mr. V is receiving treatment for a spinal cord injury after falling off of his deck at home. He has undergone spinal surgery and has been placed in a halo traction device. Which of the following nursing interventions is most appropriate for a client with a spinal cord injury?

• A. Turn the client and use incentive spirometry each shift
• B. Administer stool softeners as ordered
• C. Turn the head slowly to avoid further damage to the spine
• D. Change NPO status

Correct answer: B

Rationale: In a client with a spinal cord injury, administering stool softeners as ordered is a crucial nursing intervention. Patients with spinal cord injuries are at higher risk of constipation due to decreased mobility. Stool softeners help prevent constipation and potential fecal impaction. Turning the client and using incentive spirometry each shift can be beneficial for respiratory function but is not the most vital intervention in this scenario. Turning the head slowly to avoid further damage to the spine is important but is not directly related to preventing constipation. Changing NPO status is not relevant to preventing constipation or managing a spinal cord injury.

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