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. What physical assessment data should the nurse consider a normal finding for a primigravida client who is 12 hours postpartum?

• A. Soft, spongy fundus.
• B. Saturating two perineal pads per hour.
• C. Pulse rate of 56 BPM.
• D. Unilateral lower leg pain.

Correct answer: C

Rationale: The correct answer is C. A pulse rate of 56 BPM can be considered a normal finding for a primigravida client who is 12 hours postpartum. Postpartum bradycardia can occur due to increased stroke volume and decreased vascular resistance after delivery. It is important for the nurse to monitor the client's vital signs and recognize that a lower pulse rate can be expected in the immediate postpartum period. Choices A, B, and D are incorrect because a soft, spongy fundus may indicate uterine atony, saturating two perineal pads per hour is excessive bleeding, and unilateral lower leg pain could suggest deep vein thrombosis, all of which would require further assessment and intervention.

3. A client with heart failure is receiving intravenous furosemide (Lasix). Which assessment finding indicates that the medication is having the desired effect?

• A. Decreased peripheral edema.
• B. Elevated blood pressure.
• C. Increased heart rate.
• D. Decreased urine output.

Correct answer: A

Rationale: The correct answer is A: 'Decreased peripheral edema.' In a client with heart failure receiving furosemide, decreased peripheral edema indicates that the medication is effectively reducing fluid overload. Furosemide is a diuretic that helps the body eliminate excess fluid and salt through increased urine output, leading to a reduction in peripheral edema, which is a common symptom of heart failure. Monitoring and recognizing this improvement in edema are crucial in managing heart failure effectively.

4. A healthcare professional is interested in studying the incidence of infant death in a particular city and wants to compare that city's rate to the state's rate. What state resource is most likely to provide this information?

• A. Disease registry.
• B. Department of Health.
• C. Bureau of Vital Statistics.
• D. Census data.

Correct answer: C

Rationale: The Bureau of Vital Statistics collects data on births and deaths, including infant mortality rates. This data is crucial for healthcare professionals to analyze and compare rates between different regions.

5. After a client with ascites due to liver cirrhosis undergoes a paracentesis, what should the nurse do post-procedure?

• A. Encourage the client to drink plenty of fluids
• B. Monitor the client's blood pressure and heart rate
• C. Position the client flat on their back
• D. Administer a dose of furosemide

Correct answer: B

Rationale: Post-paracentesis, monitoring the client's blood pressure and heart rate is crucial as it helps in early detection of potential complications such as hypotension or bleeding. This close observation enables timely intervention and ensures the client's safety.

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