Nursing Elites

1. The nurse is caring for a 73-year-old man with cirrhosis. Which data obtained by the nurse during the assessment will be of most concern?

• A. The patient complains of right upper-quadrant pain upon palpation.
• B. The patient's hands flap back and forth when the arms are extended.
• C. The patient has ascites and a 2-kg weight gain from the previous day.
• D. The patient's skin has multiple spider-shaped blood vessels on the abdomen.

Correct answer: B

Rationale: The most concerning data obtained by the nurse is the patient's hands flapping back and forth when the arms are extended, indicating asterixis, which is associated with hepatic encephalopathy. This condition can progress to hepatic coma and requires immediate attention. The presence of spider angiomas and right upper-quadrant abdominal pain are common findings in cirrhosis and do not warrant urgent intervention. Although ascites and weight gain suggest the need for treatment, they are not as alarming as the neurologic manifestations seen in hepatic encephalopathy.

2. Application - The nurse is caring for a patient who has the following labs: Creatinine 2.5mg/dL, WBC 11,000 cells/mL, and Hemoglobin of 12 g/dL. Based on this information, which of these orders would the nurse question?

• A. Administer 30 Units of Lantus Daily
• B. CT of the spine with contrast
• C. X-ray of the abdomen and chest
• D. Administer heparin subcutaneously 5,000 Units every 12 hours

Correct answer: B

Rationale: The correct answer is to question the order for a CT of the spine with contrast. The patient's elevated creatinine level of 2.5mg/dL indicates impaired kidney function. Contrast agents are nephrotoxic and can further compromise kidney function in patients with existing nephropathy. Therefore, it is crucial to avoid contrast-enhanced imaging studies in patients with impaired renal function. Choice A: Administering 30 Units of Lantus Daily is not contraindicated based on the provided lab values. Choice C: Ordering an X-ray of the abdomen and chest is not contraindicated based on the provided lab values. Choice D: Administering heparin subcutaneously at 5,000 Units every 12 hours is not contraindicated based on the provided lab values.

3. A patient diagnosed with alopecia would be described as having:

• A. body lice
• B. lack of ear lobes
• C. Indigestion
• D. hair loss

Correct answer: D

Rationale: The correct answer is 'hair loss.' Alopecia is a medical term that specifically refers to the condition of hair loss, usually in patches or all over the body. Choice A, 'body lice,' refers to a parasitic infestation and is not related to alopecia. Choice B, 'lack of ear lobes,' is completely unrelated to the term alopecia, which is solely about hair loss. Choice C, 'Indigestion,' has no connection to alopecia as it pertains to digestive issues, not hair loss. Therefore, the correct description for a patient diagnosed with alopecia is 'hair loss.'

4. A mother brings her child to the well-child clinic and expresses concern to the nurse because the child has been playing with another child diagnosed with hepatitis. The nurse prepares to perform an assessment on the child, knowing that which finding would be of least concern for hepatitis?

• A. Jaundice
• B. Hepatomegaly
• C. Dark-colored, frothy urine
• D. Left upper abdominal quadrant pain

Correct answer: D

Rationale: Assessment findings in a child with hepatitis typically include right upper quadrant tenderness and hepatomegaly. The child may also present with pale, clay-colored stools and dark, frothy urine. Jaundice, which can be observed in the sclerae, nail beds, and mucous membranes, is a common sign of hepatitis. Left upper abdominal quadrant pain is not a typical finding associated with hepatitis; therefore, it would be of least concern in this scenario. The other options are more commonly associated with hepatitis and are important signs to monitor for in a child with possible exposure to the virus.

5. Which of the following measures would be appropriate for a nurse to teach the parent of a nine-month-old infant about diaper dermatitis?

• A. Use only cloth diapers that are rinsed in bleach
• B. Do not use occlusive ointments on the rash
• C. Use commercial baby wipes with each diaper change
• D. Discontinue a new food that was added to the infant's diet just prior to the rash

Correct answer: D

Rationale: Diaper dermatitis can be caused by various factors, one of which includes introducing new foods to the infant's diet. Discontinuing the new food that was added just before the rash can help identify and eliminate the potential cause. Options A and C are not directly related to addressing the cause of diaper dermatitis. While using cloth diapers rinsed in bleach may be a preventive measure for diaper dermatitis, it is not addressing a specific cause. Option B, advising against using occlusive ointments on the rash, may actually be beneficial in managing diaper dermatitis, but it does not address the cause of the condition.

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