Nursing Elites

1. What is/are the possible cause(s) of acute pancreatitis in this patient?

• A. HIV
• B. Cytomegalovirus
• C. Dideoxyinosine (ddI)
• D. Pentamidine

Correct answer: B

Rationale: This patient presents with symptoms and lab findings consistent with acute pancreatitis. Cytomegalovirus is a common viral infection associated with pancreatitis. In patients with AIDS, the pancreas can be affected by various infections (e.g., cryptococcus, Mycobacterium tuberculosis, candida, Toxoplasma gondii) and medications (such as ddI, pentamidine, trimethoprim/sulfamethoxazole, metronidazole) can also lead to acute pancreatitis. While HIV infection predisposes individuals to various opportunistic infections, in this case, the most likely cause of the acute pancreatitis is cytomegalovirus infection.

2. A client with a history of chronic alcohol use is admitted with confusion and an unsteady gait. Which deficiency should the nurse suspect?

• A. Thiamine (Vitamin B1)
• B. Cyanocobalamin (Vitamin B12)
• C. Folic acid
• D. Vitamin D

Correct answer: A

Rationale: The correct answer is Thiamine (Vitamin B1). Chronic alcohol use can lead to thiamine deficiency, which can result in neurological symptoms such as confusion and an unsteady gait. Thiamine is essential for proper brain function and nerve conduction, and its deficiency is common in individuals with alcohol use disorder. Cyanocobalamin (Vitamin B12) deficiency can also present with neurological symptoms, but in this case, the patient's history of chronic alcohol use points more towards thiamine deficiency. Folic acid deficiency typically presents with symptoms like fatigue and megaloblastic anemia. Vitamin D deficiency is associated with bone health issues rather than neurological symptoms.

3. The healthcare provider in the outpatient clinic has obtained health histories for these new patients. Which patient may need referral for genetic testing?

• A. 35-year-old patient whose maternal grandparents died after strokes at ages 90 and 96
• B. 18-year-old patient with a positive pregnancy test whose first child has cerebral palsy
• C. 34-year-old patient who has a sibling with newly diagnosed polycystic kidney disease
• D. 50-year-old patient with a history of cigarette smoking who is complaining of dyspnea

Correct answer: C

Rationale: The 34-year-old patient who has a sibling with newly diagnosed polycystic kidney disease may need referral for genetic testing. Polycystic kidney disease is an autosomal dominant disorder that can be asymptomatic until later in life. Presymptomatic testing can provide valuable information for guiding lifestyle and family planning decisions. The other patients do not present indications for genetic testing based on the information provided in their health histories. The 35-year-old patient's maternal grandparents' strokes are not indicative of a need for genetic testing. The 18-year-old patient's child having cerebral palsy is not a direct indication for genetic testing of the patient herself. The 50-year-old patient's symptoms are more likely related to smoking and respiratory issues, not genetic predisposition to a specific disease.

4. A client in acute renal failure has a serum potassium level of 6.3 mEq/L. What intervention can the nurse expect the healthcare provider to prescribe?

• A. Nitrofurantoin (Macrodantin) orally.
• B. Erythropoietin (Epogen) intravenously.
• C. Kayexalate retention enema.
• D. Azathioprine (Imuran) orally.

Correct answer: C

Rationale: In acute renal failure with high serum potassium levels, the healthcare provider is likely to prescribe a Kayexalate retention enema. Kayexalate is a medication used to lower elevated potassium levels by promoting potassium excretion through the gastrointestinal tract, thus aiding in the management of hyperkalemia in clients with renal failure.

5. A patient with cirrhosis of the liver and ascites is scheduled for a paracentesis. What should the nurse do to prepare the patient for the procedure?

• A. Have the patient void immediately before the procedure.
• B. Position the patient upright or semi-Fowler's in bed.
• C. Administer a full liquid diet.
• D. Encourage the patient to ambulate for 30 minutes.

Correct answer: A

Rationale: The correct preparation for a paracentesis in a patient with cirrhosis and ascites includes having the patient void immediately before the procedure. This is important to reduce the risk of bladder puncture during the paracentesis. Positioning for a paracentesis is typically upright or semi-Fowler's, not flat in bed. Administering a full liquid diet or encouraging ambulation for 30 minutes are not directly related to preparing a patient for a paracentesis procedure.

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