Nursing Elites

1. Which action will be included in the care for a patient who has recently been diagnosed with asymptomatic nonalcoholic fatty liver disease (NAFLD)?

• A. Teach about symptoms of variceal bleeding
• B. Draw blood for hepatitis serology testing
• C. Discuss the need to increase caloric intake
• D. Review the patient's current medication list

Correct answer: D

Rationale: The correct action for a patient diagnosed with asymptomatic nonalcoholic fatty liver disease (NAFLD) would be to review the patient's current medication list. This is important because certain medications can increase the risk for NAFLD, and they should be identified and possibly eliminated. Teaching about symptoms of variceal bleeding is not necessary as variceal bleeding is not a concern in a patient with asymptomatic NAFLD. Drawing blood for hepatitis serology testing is not indicated as NAFLD is not associated with hepatitis. Discussing the need to increase caloric intake is also not appropriate since weight loss is usually recommended in the management of NAFLD.

2. During an admission assessment on a 2-year-old child diagnosed with nephrotic syndrome, the nurse notes that which characteristic is most commonly associated with this syndrome?

• A. Hypertension
• B. Generalized edema
• C. Increased urinary output
• D. Frank, bright red blood in the urine

Correct answer: B

Rationale: Nephrotic syndrome in children is characterized by massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema. The most common manifestation is generalized edema due to protein loss in the urine, leading to decreased plasma oncotic pressure. This results in fluid shifting into the interstitial spaces, causing edema. Hypertension is not a typical feature of nephrotic syndrome in children. Increased urinary output is not a common finding; instead, children with nephrotic syndrome often have decreased urine output due to decreased renal perfusion. The presence of frank, bright red blood in the urine is not a typical characteristic of nephrotic syndrome but may indicate a different renal condition such as glomerulonephritis.

3. Which pathologic condition is described as 'increased intraocular pressure of the eye'?

• A. Detached Retina
• B. Fovea Centralis
• C. Presbyopia
• D. Glaucoma

Correct answer: D

Rationale: The correct answer is Glaucoma. Glaucoma is a condition characterized by increased intraocular pressure in the eye, which can lead to optic nerve damage, vision loss, and blindness if left untreated. Detached Retina (A), Fovea Centralis (B), and Presbyopia (C) are not conditions associated with increased intraocular pressure like Glaucoma. Detached Retina is a separation of the retina from its underlying tissue, Fovea Centralis is a part of the retina responsible for sharp central vision, and Presbyopia is an age-related condition affecting near vision due to the loss of flexibility in the eye's lens.

4. The nurse is performing tuberculosis (TB) skin tests in a clinic that has many patients who have immigrated to the United States. Which question is most important for the nurse to ask before the skin test?

• A. Is there any family history of TB?
• B. How long have you lived in the United States?
• C. Do you take any over-the-counter (OTC) medications?
• D. Have you received the bacille Calmette-Guerin (BCG) vaccine for TB?

Correct answer: D

Rationale: It is crucial for the nurse to inquire about whether the patient has received the bacille Calmette-Guerin (BCG) vaccine for TB before performing the skin test. Patients who have received the BCG vaccine can have a positive Mantoux test, leading to the need for alternative screening methods, such as a chest x-ray, to determine TB infection. While family history of TB and length of time in the United States are relevant factors, they do not directly impact the decision to perform the TB skin test. Asking about over-the-counter medications, unless relevant to TB treatment, is not as critical as assessing BCG vaccination status.

5. A patient who has a right-sided chest tube following a thoracotomy has continuous bubbling in the suction-control chamber of the collection device. Which action by the nurse is most appropriate?

• A. Document the presence of continuous bubbling.
• B. Notify the surgeon of a possible pneumothorax.
• C. Take no further action with the collection device.
• D. Adjust the dial on the wall regulator to decrease suction.

Correct answer: C

Rationale: Continuous bubbling in the suction-control chamber of the chest tube collection device is an expected finding and indicates that the suction control chamber is connected to suction. It does not necessarily indicate a large air leak, which would be detected in the water-seal chamber. There is no evidence to suggest a pneumothorax based solely on continuous bubbling in the suction-control chamber. Adjusting the suction level by changing the wall regulator setting is not indicated in this situation, as the amount of suction applied is primarily regulated by the water level in the water-seal chamber and not by the vacuum source. Therefore, the most appropriate action in this scenario is for the nurse to take no further action with the collection device.

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