Nursing Elites

1. What is the most likely diagnosis in a 30-year-old woman with right upper quadrant pain, fever, and jaundice, along with elevated white blood cell count and bilirubin levels?

• A. Acute hepatitis
• B. Acute cholecystitis
• C. Acute cholangitis
• D. Pancreatic cancer

Correct answer: C

Rationale: The combination of right upper quadrant pain, fever, jaundice, elevated white blood cell count, and bilirubin levels is classic for acute cholangitis, which is an infection of the bile ducts. Acute hepatitis typically presents with other liver function abnormalities, while acute cholecystitis is characterized by gallbladder inflammation. Pancreatic cancer would not typically present with these specific symptoms and lab findings.

2. A patient with gout is prescribed allopurinol. What should the nurse include in the patient teaching?

• A. Take the medication with food.
• B. Increase intake of high-purine foods.
• C. Limit fluid intake to 1 liter per day.
• D. Expect immediate pain relief.

Correct answer: A

Rationale: When educating a patient prescribed allopurinol for gout, the nurse should emphasize taking the medication with food to reduce the risk of gastrointestinal upset. It is important to instruct the patient to maintain adequate hydration by consuming plenty of fluids, preferably water, to help prevent kidney stone formation and facilitate the drug's effectiveness. Allopurinol does not provide immediate pain relief but rather works to lower uric acid levels over time, reducing the frequency of gout attacks. Choices B and C are incorrect as increasing high-purine foods can exacerbate gout symptoms, and limiting fluid intake to 1 liter per day is not recommended for gout patients who should maintain good hydration. Choice D is incorrect because allopurinol does not offer immediate pain relief.

3. A client admitted with a diagnosis of sepsis has a central venous pressure (CVP) of 15 mm Hg. What should the nurse do first?

• A. Administer a fluid bolus of 500 ml.
• B. Notify the healthcare provider immediately.
• C. Administer a diuretic.
• D. Continue to monitor the CVP.

Correct answer: B

Rationale: A CVP of 15 mm Hg is higher than normal, indicating possible fluid overload or heart failure, which needs immediate attention. Notifying the healthcare provider is crucial as they can evaluate the client's condition, order appropriate interventions, and prevent potential complications.

4. A client with cirrhosis of the liver is being cared for by the healthcare team. Which clinical manifestation indicates that the client has developed hepatic encephalopathy?

• A. Asterixis.
• B. Jaundice.
• C. Ascites.
• D. Splenomegaly.

Correct answer: A

Rationale: Asterixis, also known as flapping tremor, is a characteristic sign of hepatic encephalopathy, a severe complication of liver cirrhosis. Hepatic encephalopathy results from the liver's inability to detoxify substances in the body, leading to neurologic manifestations such as changes in mental status, confusion, and asterixis.

5. A patient with bipolar disorder is prescribed lithium. What dietary advice should the nurse provide?

• A. Increase intake of caffeine.
• B. Maintain a consistent salt intake.
• C. Avoid dairy products.
• D. Increase intake of green leafy vegetables.

Correct answer: B

Rationale: The correct answer is B: Maintain a consistent salt intake. Patients prescribed lithium should maintain a consistent salt intake to help stabilize lithium levels. Fluctuations in salt intake can affect the levels of lithium in the body, potentially leading to toxicity or reduced effectiveness of the medication. It is important for patients to be consistent with their salt intake and to avoid sudden increases or decreases. Choices A, C, and D are incorrect. Increasing intake of caffeine is not recommended as it can interfere with the effects of lithium. Avoiding dairy products is not necessary unless there are specific intolerances or interactions with other medications. While green leafy vegetables are generally healthy, there is no specific recommendation to increase their intake in relation to lithium therapy.

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