Exit Exam (BSN 366)

Correct Answer: A semi-private room on a surgical unit

Explanation:

A semi-private room on a surgical unit is the most appropriate setting for a postpartum patient with an infected surgical wound. Surgical units are equipped with staff experienced in managing postoperative complications, including wound infections. These units are designed to closely monitor surgical patients and implement infection control protocols effectively. Although the room is semi-private, proper precautions such as hand hygiene, wound care, and potential isolation protocols ensure patient safety and reduce the risk of spreading infection. The surgical environment provides optimal care for her recovery.

Why the other options are incorrect:

A negative pressure room

Negative pressure rooms are specifically designed for patients with airborne transmissible diseases such as tuberculosis, measles, or varicella. These rooms help prevent the spread of pathogens through the air by maintaining lower air pressure inside the room. This patient's surgical wound infection is not airborne, so a negative pressure room is unnecessary and would misallocate a specialized resource intended for those with contagious respiratory illnesses. Using this room inappropriately can also reduce availability for patients who actually need airborne precautions.

A postpartum room in the birthing center

While it may seem logical to place a postpartum patient in the birthing center, this area is primarily for mothers recovering from uncomplicated deliveries. This patient’s condition—an infected cesarean wound—requires specialized postoperative care that the birthing center may not be equipped to provide. Additionally, the presence of an infection poses a potential risk to other postpartum women and vulnerable newborns in the unit, making this setting inappropriate both from a care and infection control perspective.

A private room on a medical unit

Though a private room may offer infection control advantages, a general medical unit lacks the specialized staff and resources needed to manage surgical wound infections effectively. Surgical units are better suited for handling complications following operations, including infection surveillance and wound management. A common misconception is that any private room is automatically the best option for infection control, but the clinical context and staff expertise are equally, if not more, important in determining appropriate placement.

Correct Answer: Defibrillation at 200 joules

Defibrillation is the critical intervention for ventricular fibrillation (VF), a life-threatening arrhythmia. In VF, the heart's electrical activity becomes disorganized, leading to ineffective pumping. Defibrillation delivers an electrical shock to the heart, briefly halting its activity and allowing the natural pacemaker to restore a normal rhythm. The 200-joule setting is standard for initial defibrillation in this situation. Immediate defibrillation is necessary to improve survival chances, as VF is rapidly fatal if not treated.

Why the other options are incorrect:

Prepare for intubation

While airway management may be required if the patient is unable to breathe on their own, the first priority in this scenario is to address the heart’s rhythm with defibrillation. Intubation can follow if necessary but should not take precedence over defibrillation, as restoring circulation and rhythm is more time-sensitive in this case.

Insert intravenous catheter

Although IV access is important for administering medications or fluids during resuscitation, it is secondary to defibrillation in this case. The primary goal in VF is to restore a normal heart rhythm, and defibrillation takes precedence over establishing an IV line.

Obtain arterial blood gases (ABGs)

While ABG analysis can help assess oxygenation and metabolic status, it is not urgent in the acute treatment of VF. The focus should first be on defibrillation to address the life-threatening arrhythmia. ABGs can be taken later once the patient's heart rhythm is stabilized.

The correct answers are:

Eat more canned vegetables

Consume foods with saturated fat

Use a salt substitute

Explanation:

These three statements indicate a need for further education because they reflect misunderstandings about proper dietary practices for managing coronary artery disease. Managing this condition requires limiting sodium and saturated fat intake while promoting heart-healthy choices.

Eat more canned vegetables:

Canned vegetables often contain high levels of sodium, which can increase blood pressure and worsen coronary artery disease. Excessive sodium intake contributes to fluid retention and hypertension, placing additional strain on the cardiovascular system. Instead, clients should be encouraged to choose fresh or frozen vegetables, or low-sodium canned options.

Consume foods with saturated fat:

Saturated fats, found in animal products like red meat, butter, and full-fat dairy, contribute to increased low-density lipoprotein (LDL) cholesterol levels. Elevated LDL cholesterol promotes plaque buildup in the arteries, increasing the risk of heart disease. Clients should be instructed to limit saturated fat intake and opt for healthier fats like unsaturated fats from avocados, nuts, and olive oil.

Use a salt substitute:

Many salt substitutes contain potassium chloride, which can be dangerous for clients with coronary artery disease, particularly those taking medications like ACE inhibitors or potassium-sparing diuretics. Excess potassium can lead to hyperkalemia, which poses a serious risk to heart health. Clients should be encouraged to flavor food using herbs, spices, or lemon juice instead.

Why the Other Options Are Incorrect:

Keep a food diary:

This is a correct practice. Keeping a food diary helps clients track their eating habits, recognize patterns, and identify areas for improvement. It also allows healthcare providers to monitor dietary adherence and suggest modifications to promote heart health"

Walk 30 minutes per day:

This is a correct practice. Engaging in regular physical activity, such as walking, helps lower blood pressure, reduce cholesterol levels, and maintain a healthy weight. The American Heart Association recommends at least 150 minutes of moderate-intensity exercise per week to support cardiovascular health.

Include oatmeal for breakfast:

This is a correct practice. Oatmeal is rich in soluble fiber, which helps lower LDL cholesterol. Incorporating fiber-rich foods like oatmeal into the diet supports heart health by reducing cholesterol absorption in the bloodstream.

Summary:

The statements that require additional education are "Eat more canned vegetables," "Consume foods with saturated fat," and "Use a salt substitute." These behaviors can increase the risk of worsening coronary artery disease. Effective education should focus on reducing sodium and saturated fat intake while encouraging heart-healthy alternatives like fresh produce, unsaturated fats, and safe seasoning options.

The correct answer is:

Neurovascular checks.

Rationale:

The priority for a client with a fractured femur and a full leg cast is performing neurovascular checks. This includes assessing circulation, motor function, and sensation in the affected leg. Neurovascular checks are crucial for identifying early signs of complications such as compartment syndrome, a medical emergency that can occur when swelling increases within a muscle compartment, reducing blood flow and causing tissue damage. Regular monitoring of pulses, color, temperature, capillary refill, and sensation helps detect potential issues before they escalate, making it the most urgent priority in this scenario.

Why the Other Options Are Incorrect:

Leg elevation

Although leg elevation is important for reducing swelling and promoting circulation, it is not the first priority. The primary concern is ensuring that there are no complications, such as compromised circulation or nerve damage. Neurovascular checks must be performed first to rule out urgent concerns like compartment syndrome. Once the neurovascular status is stable, elevation can be implemented as part of ongoing care.

Pain management

Pain management is an essential part of care, but it is not the priority in the acute phase after a fracture and cast application. The first concern is ensuring that there are no signs of critical complications like compromised circulation or nerve damage. Once neurovascular checks are completed and the leg is stable, appropriate pain management can be administered.

Ambulation teaching

While teaching ambulation is important for the client’s recovery, it can be addressed later once the client's condition is stable and complications have been ruled out. The priority immediately following a femur fracture and cast application is to monitor for signs of severe complications, not to focus on mobility training, which can be done once the situation is under control.

Correct Answer: A slight fever is often associated with teething, but a fever lasting more than three days requires medical attention.

Explanation:

Teething can cause mild symptoms such as drooling, irritability, and mild discomfort. A slight fever may also occur, but this is usually brief and not severe. If the fever lasts more than three days or exceeds 100.4°F (38°C), it could indicate an underlying infection or other medical issue, and it is important for parents to seek medical attention. Educating parents about when to seek help for a prolonged fever ensures that any serious conditions are addressed promptly.

Why the other options are incorrect:

Though child development is characterized by individual differences, first teeth usually erupt during the seventh month:

While this information is relevant to general child development, it is not the priority in this scenario. The question is about managing a fever in a teething infant, not about the exact timing of tooth eruption. Parents should be informed about fever management rather than the specific timing of teething.

Providing cooled teething toys can help decrease the discomfort associated with tooth eruption:

This is indeed useful advice for managing mild teething discomfort. However, the primary concern in this case is the fever, which could be a sign of something more serious than just teething. The main focus should be on when to seek medical attention if a fever persists.

No action is required for the common symptoms associated with teething, which include drooling, irritability, and poor sleeping:

While it is true that these symptoms typically do not require medical intervention, it is important to provide guidance on recognizing when symptoms like fever could indicate something more serious. Simply reassuring parents that no action is needed may cause them to overlook more concerning symptoms.

The correct answer is:

Urine output to 55 ml/hr.

Rationale:

Dopamine (Intropin) is commonly administered to critically ill clients, especially those who are hypotensive, as it can help improve renal perfusion and promote urine output. At low doses (typically 1-5 mcg/kg/min), dopamine primarily stimulates dopaminergic receptors, leading to vasodilation of the renal, mesenteric, coronary, and cerebral vasculature. This effect improves kidney function, increases urine output, and helps maintain renal perfusion in clients with low blood pressure.

Why the Other Choices Are Incorrect:

Blood pressure to 140/80:

While dopamine can help raise blood pressure by increasing cardiac output and improving vascular tone, its intended effect is not to achieve a specific target blood pressure like 140/80. The goal is generally to improve the blood pressure to a level that supports organ perfusion and vital functions. Dopamine is not typically used to achieve a specific blood pressure goal, and it is used more for stabilization than for specific target values.

Pulse to 132 beats/min:

Dopamine increases heart rate to some degree by stimulating beta-1 adrenergic receptors, but it is not primarily intended to achieve a specific pulse rate like 132 beats/min. The goal of dopamine administration is to increase cardiac output and improve tissue perfusion, not necessarily to achieve a specific heart rate.

Respirations to 24 breaths/min:

Dopamine does not have a direct effect on respiratory rate. While improved cardiac output and oxygenation could potentially support better respiratory function, dopamine is not used to regulate respiratory rate directly. If the client is experiencing respiratory distress, other interventions such as oxygen therapy or mechanical ventilation would be more appropriate.

Correct Answer:

Roasted turkey, canned vegetables.

Explanation:

A low-fiber diet is recommended for clients with ulcerative colitis to reduce bowel irritation and minimize the risk of diarrhea and abdominal cramping. This diet avoids high-fiber foods such as raw fruits and vegetables, whole grains, and tough meats.

Roasted turkey is a lean protein that is easy to digest and does not contain fiber. Canned vegetables (without seeds or skins) are softer, lower in fiber than fresh vegetables, and easier on the digestive system.

Why the Other Options Are Incorrect:

Roast pork, fresh strawberries:

Roast pork can be fatty and harder to digest, which may worsen symptoms in ulcerative colitis. Fresh strawberries are high in fiber and contain seeds, which can irritate the bowel lining.

Baked potato with skin, raw carrots:

The baked potato skin is high in fiber and should be avoided. A peeled, well-cooked potato would be a better choice. Raw carrots are high in insoluble fiber, which can irritate the colon, especially in an inflamed state. Cooking vegetables until soft is recommended.

Pancakes, whole-grain cereals:

Whole-grain cereals are high in fiber and are not suitable for a low-fiber diet. While pancakes can be included if made with refined flour (not whole grain), the presence of whole-grain cereal in the meal makes this option incorrect.

Correct Answer: A client with an epidural infusion reports lower extremity paresthesia

This situation requires immediate RN intervention because lower extremity paresthesia (numbness or tingling) could indicate a serious complication related to the epidural infusion. Potential issues include nerve compression, adverse medication reactions, or an infection. These symptoms might be signs that the epidural catheter is affecting the spinal cord or nerves, requiring urgent evaluation to prevent permanent damage. Early detection and intervention are critical in preventing further harm to the client.

Why the other options are incorrect:

A client receiving Lactated Ringer's solution requests pain medication

This is a common and non-urgent situation. While pain medication may need to be administered, it does not indicate an immediate or critical issue requiring RN intervention. The RN or PN can assess the client’s pain level and administer the medication following protocol, which is within their scope of practice.

A client with a history of falls needs assistance to the bathroom

This scenario does not indicate an immediate need for RN intervention. The RN or PN can assess the client’s fall risk and assist the client to the bathroom safely. However, this is a routine task that involves providing safety measures rather than urgent medical intervention. The client's safety should always be ensured, but this situation is not an emergency.

A client's indwelling urinary catheter requires manual irrigation

Manual irrigation of an indwelling urinary catheter is a standard procedure that can be safely performed by a PN, as long as the client’s condition does not require further assessment or intervention by the RN. This task is within the PN's scope of practice and does not indicate an acute issue that demands RN attention.

The correct answer is: Reposition the infant every two hours.

Explanation:

Repositioning the infant every two hours ensures even exposure to phototherapy light, which is essential for breaking down bilirubin and preventing complications such as pressure sores and heat loss. Proper repositioning also helps reduce the risk of excessive heat accumulation in one area of the infant’s body.

Why the Other Options Are Incorrect:

Cover with a receiving blanket:

Covering the infant with a receiving blanket would block the phototherapy light from reaching the skin, making the treatment ineffective. Phototherapy works by converting bilirubin into a form that can be excreted, and direct skin exposure is necessary for this process.

Perform diaper changes under the light:

While frequent diaper changes are necessary to keep the infant clean and comfortable, performing them under the light does not directly contribute to the effectiveness of phototherapy. Instead, the priority should be maximizing skin exposure while ensuring the infant remains warm and hydrated.

Feed the infant every four hours:

Newborns undergoing phototherapy require frequent feeding, typically every two to three hours, rather than every four hours. This is because increased hydration and frequent bowel movements help eliminate bilirubin from the body through stool and urine.

Summary:

The correct answer is Reposition the infant every two hours because it ensures effective phototherapy by allowing even light exposure, preventing complications, and maximizing bilirubin breakdown. Other choices are incorrect because they either interfere with phototherapy effectiveness or do not directly contribute to bilirubin elimination.