Nursing Elites

1. When administering a-interferon and ribavirin (Rebetol) to a patient with chronic hepatitis C, the nurse should monitor for which complication?

• A. Leukopenia.
• B. Hypokalemia.
• C. Polycythemia.
• D. Hypoglycemia.

Correct answer: B

Rationale: When administering a-interferon and ribavirin (Rebetol) for chronic hepatitis C, the nurse should monitor for hypokalemia. This combination therapy is known to cause leukopenia, not polycythemia or hypoglycemia. Hypokalemia is a common electrolyte imbalance that can occur with these medications, making it the correct answer to monitor for in this case.

2. A patient with severe mitral regurgitation and decreased cardiac output is being cared for by a nurse. The nurse assesses the patient for mental status changes. What is the rationale for this intervention?

• A. Decreased cardiac output can cause hypoxia to the brain
• B. Mental status changes may be a side effect of the patient's medication
• C. Mitral regurgitation is a complication associated with some neurological disorders
• D. The patient may be confused about his diagnosis

Correct answer: A

Rationale: When caring for a patient with severe mitral regurgitation and decreased cardiac output, assessing for mental status changes is crucial. Decreased cardiac output can lead to inadequate perfusion and oxygenation of vital organs, including the brain, resulting in hypoxia. This hypoxia can manifest as mental status changes such as confusion, restlessness, or lethargy. Therefore, monitoring mental status helps in identifying potential hypoxic states and guiding appropriate interventions. The other options are incorrect as they do not directly correlate decreased cardiac output with potential hypoxia-induced mental status changes.

3. A patient with acute shortness of breath is admitted to the hospital. Which action should the nurse take during the initial assessment of the patient?

• A. Ask the patient to lie down to complete a full physical assessment.
• B. Briefly ask specific questions about this episode of respiratory distress.
• C. Complete the admission database to check for allergies before treatment.
• D. Delay the physical assessment to first complete pulmonary function tests.

Correct answer: B

Rationale: When a patient presents with acute shortness of breath, the initial assessment should focus on gathering specific information relevant to the current episode of respiratory distress. A comprehensive health history or full physical examination can be deferred until the acute distress has been addressed. Asking specific questions helps determine the cause of the distress and guides appropriate treatment. While checking for allergies is important, completing the entire admission database is not a priority during the initial assessment. Likewise, delaying the physical assessment for pulmonary function tests is not recommended as the immediate focus should be on addressing the acute respiratory distress before ordering further diagnostic tests or interventions.

4. When developing a plan of care for a 6-year-old child diagnosed with acute glomerulonephritis, which intervention should the nurse prioritize?

• A. Encourage limited activity and provide safety measures.
• B. Catheterize the child to monitor intake and output strictly.
• C. Encourage the child to talk about feelings related to illness.
• D. Encourage classmates to visit and keep the child informed of school events.

Correct answer: A

Rationale: The priority intervention for a 6-year-old child diagnosed with acute glomerulonephritis should be to encourage limited activity and provide safety measures. In glomerulonephritis, children tend to restrict their activities voluntarily due to fatigue during the active phase of the disease. Catheterization for intake and output monitoring may predispose the child to infection and is not the primary intervention. Encouraging the child to talk about feelings related to the illness may not be developmentally appropriate for a 6-year-old; instead, children can express feelings through play. It is important to limit visitors to allow the child to rest and recover rather than encouraging classmates to visit and keep the child informed of school events.

5. A 28-year-old male has been found wandering around in a confusing pattern. The male is sweaty and pale. Which of the following tests is most likely to be performed first?

• A. Blood sugar check
• B. CT scan
• C. Blood cultures
• D. Arterial blood gases

Correct answer: A

Rationale: In a 28-year-old male presenting with confusion, sweating, and pallor, the most likely cause is hypoglycemia, especially with no mention of trauma or infection. Therefore, the initial test to be performed should be a blood sugar check to rule out low blood sugar levels. Checking blood sugar levels is crucial in such a scenario as hypoglycemia can lead to altered mental status. A CT scan (choice B) is not typically the initial test for altered mental status without any focal neurological signs or head trauma. Blood cultures (choice C) are more relevant in cases suspected of infection, which is not a primary concern in this scenario. Arterial blood gases (choice D) may be considered later if there are concerns about respiratory status or acid-base disturbances, but in this case, checking the blood sugar level is the most immediate and appropriate action.

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