Nokea
A hospitalized client has a platelet count of 58,000/mm³. What action by the nurse is best?
- A. Implement fall precautions
- B. Encourage high-protein foods
- C. Limit visitors to healthy adults
- D. Institute neutropenic precautions
Correct Answer: A
Rationale: A platelet count of 58,000/mm³ below 150,000 signals thrombocytopenia, raising bleeding risk, especially from falls. Implementing fall precautions curbs trauma, preventing bleeds like intracranial hemorrhage, a practical priority over dietary tweaks. High-protein foods aid healing but don't address immediate danger. Limiting visitors or neutropenic precautions fits low WBCs, not platelets 58,000 isn't neutropenic (below 1,000 neutrophils). Nurses prioritize safety, making fall precautions the best action, directly mitigating this lab's implications in a hospitalized client prone to injury.
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Appropriate statements regarding markers of outcome after major surgery in England in 2014 include:
- A. Data about each hospital's complication rates after surgery are readily available.
- B. Data about each hospital's 30-day mortality after surgery are readily available.
- C. For most procedures, 90-day mortality rate are similar to 30-day mortality rates.
- D. National Hospital Episode Statistics (HES) data are useful for monitoring the performance of units.
Correct Answer: B
Rationale: In 2014 England, surgical outcome transparency increased. Complication rates weren't universally published per hospital, varying by procedure and trust. However, 30-day mortality data were widely available, notably via NHS initiatives and specialty audits (e.g., National Joint Registry), reflecting short-term success. Ninety-day mortality often exceeds 30-day rates (e.g., in vascular surgery), capturing delayed deaths, so they're not typically similar. HES data, capturing inpatient episodes, help monitor trends and performance, though coding accuracy limits granularity. Weekend admission mortality was higher, per studies like 2015 BMJ, due to staffing and care differences. The availability of 30-day mortality data was a key quality metric, driving accountability and improvement in surgical care.
Which of the following medication is recommended for all patients with NAFLD in improving liver histology?
- A. Statins
- B. Aspirins
- C. Ursodeoxycholic acid
- D. None of the above
Correct Answer: D
Rationale: NAFLD no med fits all; statins, aspirin, ursodiol, E lack universal proof. Nurses skip this chronic blanket pill.
The nurse is caring for a 4-year-old child following surgical removal of a stage I neuroblastoma. Which of the following interventions will be most appropriate for this child?
- A. Applying aloe vera lotion to irradiated areas of skin
- B. Administering antiemetics as prescribed for nausea
- C. Giving medications as ordered via least invasive route
- D. Maintaining isolation as prescribed to avoid infection
Correct Answer: C
Rationale: Post-surgical care for a stage I neuroblastoma (localized, surgically resected) focuses on recovery with minimal invasiveness, making giving medications via the least invasive route preferably oral most appropriate for a 4-year-old. This reduces trauma, anticipates needs like pain relief, antiemetics, or steroids (e.g., dexamethasone for swelling), and suits a stable post-op child without chemotherapy or radiation yet, as stage I often requires surgery alone. Aloe vera implies radiation, not indicated here post-surgery. Antiemetics are useful but too narrow broader medication needs apply. Isolation isn't standard for stage I post-op unless immunosuppression emerges later. This intervention balances efficacy and comfort, aligning with pediatric nursing's goal to minimize distress while ensuring effective postoperative management.
What is the essence of motivational interviewing?
- A. That change strategies must exactly match the patient's motivation
- B. That behavioural change is impossible if the patient does not want it
- C. That the counsellor motivates the patient to change and increases patient involvement
- D. That the patient's motives to show unhealthy behaviour are systematically analysed
Correct Answer: C
Rationale: Motivational interviewing counsellor sparks, pulls patients in, not rigid matches, impossibles, or motive digs. Nurses roll this, a chronic engagement art.
In assigning patients with alterations related to gastrointestinal (GI) cancer, which would be the most appropriate nursing care tasks to assign to the LPN/LVN, under supervision of the team leader RN?
- A. A patient with severe anemia secondary to GI bleeding
- B. A patient who needs enemas and antibiotics to control GI bacteria
- C. A patient who needs pre-op teaching for bowel resection surgery
- D. A patient who needs central line insertion for chemotherapy
Correct Answer: B
Rationale: LPN/LVNs operate under RN supervision, handling tasks within their scope like administering enemas and antibiotics to control GI bacteria in a cancer patient, a straightforward, protocol-driven intervention to reduce infection risk before procedures. Severe anemia from GI bleeding demands RN assessment for transfusion or instability, beyond LPN scope. Pre-op teaching for bowel resection requires detailed education and evaluation, an RN duty to ensure comprehension. Central line insertion for chemotherapy involves advanced skills and risk management, reserved for RNs or specialized staff. Enemas and antibiotics fit LPN/LVN training, optimizing team efficiency while keeping complex care with RNs, aligning with safe delegation principles in GI cancer management.