Nursing Elites

1. A 24-year-old female contracts hepatitis from contaminated food. During the acute (icteric) phase of the patient's illness, what would serologic testing most likely reveal?

• A. antibody to hepatitis D (anti-HDV).
• B. hepatitis B surface antigen (HBsAg).
• C. anti-hepatitis A virus immunoglobulin G (anti-HAV IgG).
• D. anti-hepatitis A virus immunoglobulin M (anti-HAV IgM).

Correct answer: D

Rationale: Hepatitis A is primarily transmitted through the oral-fecal route. During the acute phase of hepatitis A, serologic testing typically reveals anti-hepatitis A virus immunoglobulin M (anti-HAV IgM). This antibody appears early in the course of the infection. The presence of anti-HAV IgM indicates an acute infection with hepatitis A. Choices A and B are incorrect as hepatitis D and hepatitis B antigens are not typically associated with acute hepatitis A. Choice C, anti-hepatitis A virus immunoglobulin G (anti-HAV IgG), would indicate a past infection and lifelong immunity, which is not expected during the acute phase of the illness.

2. A client who has undergone radiation therapy presents with itching, redness, burning pain, and skin sloughing on the chest and abdomen. Which nursing intervention is most appropriate for this client?

• A. Apply ointment to the skin to avoid moisture
• B. Wash the area gently with water and pat dry
• C. Use a mild antiseptic soap to wash the area and pat dry
• D. Apply talcum powder to keep the skin dry

Correct answer: B

Rationale: For a client experiencing skin symptoms like redness, itching, burning pain, and sloughing after radiation therapy, it is crucial to maintain proper skin care. Applying ointments, lotions, or powders can worsen the condition by trapping moisture and leading to further skin irritation. The most appropriate intervention is to wash the affected area gently with water to cleanse it without further irritating the skin. Using mild antiseptic soap or talcum powder can also be harsh on the compromised skin. Patting the skin dry helps prevent friction and trauma to the affected area, promoting healing and comfort.

3. Which of the following patients is at the greatest risk for a stroke?

• A. A 60-year-old male who weighs 270 pounds, has atrial fibrillation, and has had a TIA in the past
• B. A 75-year-old male who has frequent migraines, drinks a glass of wine every day, and is Hispanic
• C. A 40-year-old female who has high cholesterol and uses oral contraceptives
• D. A 65-year-old female who is African American, has sickle cell disease, and smokes cigarettes

Correct answer: A

Rationale: The correct answer is the 60-year-old male who has a combination of significant risk factors for stroke, including atrial fibrillation, a history of a transient ischemic attack (TIA), and obesity. These factors greatly increase his risk of stroke. While other choices may have some individual risk factors, they do not collectively pose as high a risk as the patient described in option A. Option B includes migraines and alcohol consumption but lacks other major risk factors seen in option A. Option C mentions high cholesterol and oral contraceptives, which are risk factors but not as significant as atrial fibrillation and a prior TIA. Option D includes smoking and sickle cell disease but lacks the crucial risk factors present in option A.

4. Which finding would necessitate an immediate change in the therapeutic plan for a patient with grade 2 hepatic encephalopathy?

• A. Weight loss of 2 lb (1 kg)
• B. Positive urine pregnancy test
• C. Hemoglobin level of 10.4 g/dL
• D. Complaints of nausea and anorexia

Correct answer: B

Rationale: A positive urine pregnancy test would require an immediate change in the therapeutic plan for a patient with grade 2 hepatic encephalopathy due to the teratogenic effects of ribavirin. Ribavirin needs to be discontinued immediately to prevent harm to the fetus. The other options, weight loss, hemoglobin level, and complaints of nausea and anorexia, are common adverse effects of the prescribed regimen and may necessitate interventions such as patient education or supportive care, but they would not mandate an immediate cessation of therapy as in the case of a positive pregnancy test.

5. How does shock typically progress?

• A. Compensated to hypotensive shock in hours and hypotensive shock to cardiac arrest in minutes
• B. Compensated to hypotensive shock in minutes and hypotensive shock to cardiac arrest in hours
• C. Hypotensive to compensated shock in hours and compensated shock to cardiac arrest in minutes
• D. Hypotensive to compensated shock in minutes and compensated shock to cardiac arrest in hours

Correct answer: A

Rationale: Shock typically progresses from a compensated state to hypotensive shock over a period of hours. In the compensated phase, the body is trying to maintain perfusion. It is crucial to identify and intervene during this phase to prevent progression to hypotensive shock, where blood pressure drops significantly. If not promptly managed, hypotensive shock can rapidly deteriorate into cardiac arrest in minutes due to inadequate perfusion to vital organs. Choices B, C, and D are incorrect as they do not follow the typical progression of shock stages as seen in clinical practice. Understanding the stages of shock and their timeframes is crucial for early recognition and appropriate intervention to prevent further deterioration.

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