Nursing Elites

1. A 35-year-old male patient presents with right upper quadrant pain, fever for the past 48 hours, preceded by new onset jaundice over the past few weeks. He states that he has had diarrhea on and off for several years but never had this investigated. A liver ultrasound is negative for gallstones or evidence of cholecystitis. His lab tests reveal total bilirubin 6.2, alkaline phosphatase 450, AST 150, ALT 120, albumin 2.6. The next diagnostic test of choice would be

• A. Liver biopsy
• B. Magnetic resonance cholangiopancreatography
• C. Hepatitis B surface antigen and hepatitis C RNA assay
• D. Colonoscopy with biopsies

Correct answer: B

Rationale: The patient's presentation with right upper quadrant pain, fever, and jaundice, along with abnormal liver function tests, suggests a biliary tract problem. Given the suspicion of obstructed bile flow and the negative liver ultrasound for gallstones, magnetic resonance cholangiopancreatography (MRCP) is the next appropriate step to evaluate the biliary system and pancreatic ducts. MRCP is non-invasive and can provide detailed images for diagnosis. Liver biopsy is not the preferred initial diagnostic test in this context. Testing for hepatitis B and C would not address the current clinical scenario, and colonoscopy is not indicated for the presenting symptoms.

2. In which situation is it most important for the registered nurse (RN) working on a medical unit to provide direct supervision?

• A. A graduate nurse needs to access a client's implanted port to start an infusion of Ringer's Lactate.
• B. A postpartum nurse pulled to the unit needs to start a transfusion of packed red blood cells.
• C. A practical nurse is preparing to assist the healthcare provider with a lumbar puncture at the bedside.
• D. An unlicensed assistive personnel is preparing to weigh an obese bedfast client using a bed scale.

Correct answer: A

Rationale: Direct supervision is essential when a complex task, such as accessing an implanted port, is being performed by a less experienced healthcare provider, in this case, a graduate nurse. This oversight ensures patient safety and proper execution of the procedure, especially when it is the nurse's first time performing such a task.

3. For a patient with asthma, what is the primary purpose of prescribing salmeterol?

• A. Relieve acute bronchospasm
• B. Prevent asthma attacks
• C. Suppress cough
• D. Thin respiratory secretions

Correct answer: B

Rationale: Salmeterol is classified as a long-acting beta2-agonist, which is used to prevent asthma attacks by providing extended bronchodilation. It is not typically used for immediate relief of acute bronchospasm or for suppressing cough. Additionally, salmeterol does not have the primary purpose of thinning respiratory secretions.

4. Because the census is currently low in the Obstetrics (OB) unit, one of the nurses is sent to work on a medical-surgical unit for the day, or until the OB unit becomes busy. Which client assessment is best for the charge nurse to assign to the OB nurse?

• A. An adult who had a colon resection yesterday and has an IV.
• B. An older adult who has a fever of unknown origin.
• C. A woman who had an acute brain attack (stroke, CVA) 6 hours ago.
• D. A teenager with a femoral fracture who is in traction.

Correct answer: A

Rationale: The OB nurse is most experienced in postoperative care, making the client who had a recent colon resection the most suitable assignment. This client would require care that aligns closely with the expertise and skills of the OB nurse, ensuring optimal patient outcomes and effective utilization of nursing resources.

5. A patient with heart failure is prescribed digoxin. What is the most important instruction the nurse should provide?

• A. Take an extra dose if you miss one.
• B. Avoid high-potassium foods.
• C. Report any visual disturbances.
• D. Stop taking the medication if your pulse is normal.

Correct answer: C

Rationale: The correct answer is C: 'Report any visual disturbances.' Patients taking digoxin should be instructed to report any visual disturbances, as this can be a sign of digoxin toxicity. Visual disturbances like changes in color vision, blurred vision, or seeing halos around lights can indicate an overdose of digoxin. Choices A, B, and D are incorrect. Instructing a patient to take an extra dose if they miss one can lead to overdose. Avoiding high-potassium foods is important for patients on potassium-sparing diuretics, not digoxin. Stopping the medication if the pulse is normal is incorrect, as the pulse rate alone is not an indicator of digoxin effectiveness or toxicity.

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