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 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.

3. A patient with chronic heart failure is prescribed carvedilol. What is the primary purpose of this medication?

• A. Increase cardiac output
• B. Reduce fluid retention
• C. Decrease heart rate
• D. Lower blood pressure

Correct answer: C

Rationale: Carvedilol, a beta-blocker, is primarily prescribed in patients with chronic heart failure to decrease heart rate and reduce the workload on the heart. By lowering the heart rate, carvedilol helps the heart function more efficiently and improves symptoms in patients with heart failure.

4. What instruction should the nurse give regarding the administration of alendronate to a patient with osteoporosis?

• A. Take the medication with milk.
• B. Lie down for 30 minutes after taking the medication.
• C. Take the medication with a full glass of water.
• D. Take the medication before bedtime.

Correct answer: C

Rationale: The correct instruction for administering alendronate to a patient with osteoporosis is to take the medication with a full glass of water first thing in the morning. It is important for the patient to remain upright for at least 30 minutes after taking the medication to prevent esophageal irritation. Taking alendronate with milk, lying down after intake, or taking it before bedtime can reduce the medication's effectiveness or increase the risk of side effects.

5. A client who underwent a total hip replacement is receiving discharge teaching from a nurse. Which instruction should the nurse include?

• A. Avoid crossing your legs at the knees.
• B. Sit only in low chairs for comfort.
• C. Bend at the waist to pick up objects.
• D. Sleep on the affected side to prevent discomfort.

Correct answer: A

Rationale: The correct instruction the nurse should include is to avoid crossing the legs at the knees. This advice helps prevent dislocation of the new hip joint, which is a common concern after a total hip replacement surgery. Crossing the legs can place stress on the hip joint and increase the risk of dislocation. It is important for the client to follow this precaution to promote proper healing and reduce complications postoperatively.

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