Nursing Elites

1. A 50-year-old man presents with progressive jaundice, dark urine, and pruritus. Imaging reveals a mass in the head of the pancreas. What is the most likely diagnosis?

• A. Pancreatic cancer
• B. Chronic pancreatitis
• C. Gallstones
• D. Primary sclerosing cholangitis

Correct answer: A

Rationale: The presentation of progressive jaundice, dark urine, and pruritus along with a pancreatic mass, particularly in the head of the pancreas, strongly suggests pancreatic cancer as the most likely diagnosis. These symptoms are classic for obstructive jaundice caused by a mass in the head of the pancreas, making pancreatic cancer the most fitting choice.

2. A client who has been receiving treatment for depression with a selective serotonin reuptake inhibitor (SSRI) reports experiencing decreased libido. What is the best response by the nurse?

• A. Decreased libido is a common side effect of SSRIs and may improve over time.
• B. I will notify your healthcare provider to discuss possible medication changes.
• C. You should take your medication with food to reduce side effects.
• D. Increase your daily exercise to help manage this side effect.

Correct answer: B

Rationale: When a client reports experiencing decreased libido while taking SSRIs, it is important for the nurse to notify the healthcare provider to discuss potential medication adjustments. This side effect can significantly impact a client's quality of life, and addressing it promptly by involving the healthcare provider is crucial in providing holistic care. Choices A, C, and D do not directly address the issue of decreased libido caused by SSRIs. Simply waiting for improvement over time, altering the administration of medication with food, or increasing exercise are not appropriate strategies for managing this specific side effect.

3. A client in labor states, 'I think my water just broke!' The nurse notes that the umbilical cord is on the perineum. What action should the nurse perform first?

• A. Administer oxygen via face mask.
• B. Notify the operating room team.
• C. Place the client in Trendelenburg.
• D. Administer a fluid bolus of 500 ml.

Correct answer: C

Rationale: In this scenario, the priority action for the nurse is to place the client in Trendelenburg position. This position helps alleviate pressure on the umbilical cord, preventing compression and ensuring continued blood flow to the fetus. Administering oxygen, notifying the operating room team, or administering a fluid bolus are not the initial priority actions in a cord prolapse situation.

4. A client is being educated about type 2 diabetes. The educator can confirm that the client understands the primary treatment for type 2 diabetes when the client states what?

• A. I read that a pancreas transplant will provide a cure for my diabetes.
• B. I will take my oral antidiabetic agents when my morning blood sugar is high.
• C. I will make sure to follow the weight loss plan designed by the dietitian.
• D. I will make sure I call the diabetes educator when I have questions about my insulin.

Correct answer: C

Rationale: The primary treatment approach for managing type 2 diabetes includes following a weight loss plan. Weight loss can improve insulin sensitivity and glycemic control in individuals with type 2 diabetes. Making dietary changes and maintaining a healthy weight are crucial components of managing this condition.

5. What is the primary action of digoxin when prescribed to a patient with heart failure?

• A. Increase heart rate
• B. Decrease cardiac output
• C. Strengthen cardiac contractions
• D. Lower blood pressure

Correct answer: C

Rationale: Digoxin, when prescribed to a patient with heart failure, primarily acts by strengthening cardiac contractions. This leads to an improvement in cardiac output, making it an essential medication in managing heart failure. By enhancing the force of contractions, digoxin helps the heart pump more effectively and efficiently, leading to better circulation and symptom control in patients with compromised cardiac function.

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