Nursing Elites

1. A 55-year-old man presents with fatigue, pruritus, and jaundice. Laboratory tests reveal elevated bilirubin and alkaline phosphatase levels. Imaging shows dilated intrahepatic bile ducts and a normal common bile duct. What is the most likely diagnosis?

• A. Primary biliary cirrhosis
• B. Primary sclerosing cholangitis
• C. Gallstones
• D. Pancreatic cancer

Correct answer: A

Rationale: The constellation of symptoms including fatigue, pruritus, and jaundice, along with elevated bilirubin and alkaline phosphatase levels, and imaging findings of dilated intrahepatic bile ducts and a normal common bile duct, are classical features of primary biliary cirrhosis.

2. A 60-year-old woman presents with pruritus, jaundice, and xanthomas. Laboratory tests reveal elevated cholesterol and alkaline phosphatase levels. What is the most likely diagnosis?

• A. Primary biliary cirrhosis
• B. Primary sclerosing cholangitis
• C. Gallstones
• D. Pancreatic cancer

Correct answer: A

Rationale: The combination of pruritus, jaundice, and xanthomas, along with elevated cholesterol and alkaline phosphatase levels, is classic for primary biliary cirrhosis. Pruritus is often the initial symptom, followed by jaundice due to cholestasis. Xanthomas, elevated cholesterol, and alkaline phosphatase levels are also common findings in primary biliary cirrhosis. Primary sclerosing cholangitis and pancreatic cancer may present with similar symptoms but are less likely in this clinical context.

3. When should the charge nurse intervene based on the observed behavior?

• A. Two staff members are overheard talking about a cure for AIDS outside a client's room.
• B. A hospital transporter is reading a client's history and physical while waiting for an elevator.
• C. A UAP tells a client, 'It's hard to quit drinking but Alcoholics Anonymous helped me.'
• D. Two visitors are discussing a hospitalized client's history of drug abuse in the visitor's lounge.

Correct answer: B

Rationale: The hospital transporter reading a client's history and physical without a legitimate need violates patient confidentiality. This behavior requires immediate intervention to protect the client's privacy and confidentiality rights.

4. The client has received 250 ml of 0.9% normal saline through the IV line in the last hour. The client is now tachypneic and has a pulse rate of 120 beats/minute, with a pulse volume of +4. In addition to reporting the assessment findings to the healthcare provider, what action should the nurse implement?

• A. Discontinue the IV and apply pressure at the site.
• B. Decrease the saline to a keep-open rate.
• C. Increase the rate of the current IV solution.
• D. Change the IV fluid to 0.45% normal saline at the same rate.

Correct answer: B

Rationale: In this scenario, the client is showing signs of fluid overload with tachypnea and a high pulse rate. Decreasing the saline to a keep-open rate is appropriate to prevent further fluid volume excess. This action allows for IV access to be maintained while reducing the fluid administered, helping to manage the symptoms of fluid overload.

5. A patient with coronary artery disease (CAD) is prescribed a statin medication. What should the nurse include in the patient education?

• A. Take the medication with food.
• B. Report any muscle pain or weakness.
• C. Increase intake of grapefruit juice.
• D. Avoid foods high in potassium.

Correct answer: B

Rationale: Patients prescribed statin medications should be educated to report any muscle pain or weakness to their healthcare provider promptly. Muscle pain or weakness could be a sign of rhabdomyolysis, a serious side effect associated with statin use that requires medical attention. Choices A, C, and D are incorrect. Taking statins with food or increasing grapefruit juice intake are not necessary recommendations. Avoiding foods high in potassium is also not directly related to statin use.

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