An assistant nurse manager is making assignments for the next shift.
Which patient should the assistant nurse manager assign to a nurse with 6 months of experience and who has been floated from the surgical unit to the medical unit?

69-year-old with COPD who is ventilator dependent.

68-year-old who just returned from bronchoscopy and biopsy.

58-year-old on airborne precautions for tuberculosis (TB).

72-year-old who needs teaching about the use of incentive spirometry.

Answer and Explanation

The Correct Answer is D

Choice A rationale

A ventilator-dependent patient requires complex and specialized respiratory care, including ventilator management, suctioning, and frequent assessments for complications such as pneumonia or acute respiratory distress syndrome. This level of care demands advanced knowledge and experience in critical care, which a nurse with only six months of experience floated from a surgical unit may not possess, potentially compromising patient safety.

Choice B rationale

A patient recently returned from a bronchoscopy and biopsy is at risk for immediate post-procedure complications such as hemorrhage, pneumothorax, or respiratory distress. These potential acute events require prompt and skilled assessment, intervention, and monitoring, which necessitate an experienced nurse with a strong understanding of respiratory physiology and post-procedural care, beyond what a novice nurse might have.

Choice C rationale

A patient on airborne precautions for tuberculosis requires meticulous adherence to infection control protocols to prevent disease transmission. This includes proper use of N95 respirators, negative pressure rooms, and visitor management. While important, managing airborne precautions is a critical skill. However, a nurse with only six months of experience and floated from a surgical unit may not have sufficient experience with medical unit patient acuity or the complexities of managing a communicable disease.

Choice D rationale

Teaching about incentive spirometry is a routine and relatively low-risk intervention, focusing on patient education and demonstrating proper technique. This task aligns well with the skill set of a nurse with six months of experience, even if floated from another unit, as it does not typically involve complex assessments or high-acuity interventions, making it an appropriate assignment for skill reinforcement and patient engagement.

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Correct Answer is A

Explanation

Choice A rationale

The epiphyseal plate, or growth plate, is a cartilaginous area responsible for longitudinal bone growth in children. A fracture in this region can disrupt the normal physiological process of endochondral ossification, potentially leading to premature fusion or damage to the growth cartilage, resulting in limb length discrepancies or angular deformities.

Choice B rationale

While significant trauma can cause localized damage, a fracture at the epiphyseal plate primarily impacts the cartilage growth process and is not typically associated with a systemic loss of bone marrow. Bone marrow is largely confined within the medullary cavity and trabecular spaces of the bone.

Choice C rationale

The healing process for fractures, including those at the epiphyseal plate, is generally faster in younger children due to their higher metabolic rate, increased cellular activity, and robust periosteal blood supply. Pediatric bones have excellent regenerative capacity compared to adult bones, leading to more rapid remodeling.

Choice D rationale

While severe fractures can compromise local blood supply, the epiphyseal plate itself receives its vascularization from specific metaphyseal and epiphyseal arteries. A fracture can disrupt this supply, but the primary concern with epiphyseal fractures is damage to the chondrocytes and the ongoing process of bone elongation.

A. The client's dosage will be adjusted daily based on blood levels. B. The client will remain on the initial dosage during the course of treatment. C. The client will start at a high dosage, and the amount will be tapered as needed. D. The client will start on a low dosage, which can be gradually increased.

Correct Answer is D

Explanation

Choice A rationale

Adjusting levothyroxine dosage daily based on blood levels is generally not appropriate due to the drug's long half-life, which necessitates stable drug concentrations before accurate assessment. Frequent adjustments risk inducing fluctuations in thyroid hormone levels, potentially leading to hyperthyroidism or continued hypothyroidism and making precise titration challenging for maintaining euthyroid state.

Choice B rationale

Remaining on the initial dosage throughout treatment is highly improbable for levothyroxine. Thyroid hormone replacement therapy requires individualized dosing due to variations in patient metabolism, weight, and the severity of hypothyroidism. Regular monitoring of thyroid stimulating hormone (TSH) levels is essential to titrate the dose, ensuring optimal therapeutic effect and avoiding complications.

Choice C rationale

Starting levothyroxine at a high dosage is contraindicated, particularly in older adults or those with cardiovascular comorbidities, due to the risk of precipitating adverse cardiac events such as arrhythmias or angina. High doses can overwhelm the cardiovascular system, demanding increased metabolic activity. Gradual titration minimizes these risks and allows for physiological adaptation.

Choice D rationale

Starting on a low dosage and gradually increasing levothyroxine is the standard and safest approach. This strategy allows the body to adapt to the exogenous thyroid hormone, minimizing the risk of adverse effects like cardiac arrhythmias, particularly in sensitive individuals. Gradual titration prevents rapid metabolic shifts and allows for careful monitoring of patient response and TSH levels.

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An assistant nurse manager is making assignments for the next shift. Which patient should the assistant nurse manager assign to a nurse with 6 months of experience and who has been floated from the surgical unit to the medical unit?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing teaching to a parent of a child who has a fracture at the epiphyseal plate. Which of the following statements should the nurse make?

Correct Answer is A

Explanation

A nurse is caring for a client with hypothyroidism who is starting levothyroxine. What should the nurse understand about the initial start of levothyroxine for hypothyroidism?

Correct Answer is D

Explanation

A client is to receive Levothyroxine 25 mcg PO daily. Levothyroxine unit dose available is 0.05 mg/tablet. What would the nurse administer?

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An assistant nurse manager is making assignments for the next shift.
Which patient should the assistant nurse manager assign to a nurse with 6 months of experience and who has been floated from the surgical unit to the medical unit?