Nursing Elites

1. A 55-year-old woman 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 presentation of fatigue, pruritus, and jaundice in a 55-year-old woman, along with elevated bilirubin and alkaline phosphatase levels, and imaging findings of dilated intrahepatic bile ducts and a normal common bile duct, are characteristic of primary biliary cirrhosis. Primary biliary cirrhosis is an autoimmune liver disease that typically affects middle-aged women, leading to progressive destruction of the intrahepatic bile ducts.

2. The healthcare provider is assessing a client with Raynaud's phenomenon. Which finding should the healthcare provider expect?

• A. Thickened and hardened skin.
• B. Painless ulcers on the fingertips.
• C. Episodes of cyanosis and pallor in the fingers.
• D. Red, scaly patches on the hands.

Correct answer: C

Rationale: Raynaud's phenomenon is characterized by vasospasm, leading to episodes of cyanosis (bluish discoloration) and pallor (pale color) in the fingers or toes, often triggered by cold temperatures or stress. This occurs due to the reduced blood flow during vasospastic episodes, causing the discoloration. Choices A, B, and D are incorrect findings associated with other conditions and are not typical of Raynaud's phenomenon.

3. The client with chronic kidney disease (CKD) is receiving hemodialysis. Which finding should be reported to the healthcare provider immediately?

• A. Blood pressure of 150/90 mm Hg.
• B. Weight gain of 2 pounds since the last dialysis session.
• C. Blood glucose level of 120 mg/dl.
• D. Potassium level of 6.5 mEq/L.

Correct answer: D

Rationale: A potassium level of 6.5 mEq/L is dangerously high, a condition known as hyperkalemia, which can lead to severe cardiac complications like arrhythmias and cardiac arrest. Immediate medical intervention is necessary to lower potassium levels to prevent life-threatening outcomes in clients undergoing hemodialysis.

4. While assessing a client with diabetes mellitus, the nurse observes an absence of hair growth on the client's legs. What additional assessment provides further data to support this finding?

• A. Palpate for the presence of femoral pulses bilaterally.
• B. Assess for the presence of a positive Homan's sign.
• C. Observe the appearance of the skin on the client's legs.
• D. Watch the client's posture and balance during ambulation.

Correct answer: C

Rationale: The absence of hair growth on the legs in a client with diabetes mellitus can be indicative of poor circulation due to compromised blood flow. Assessing the appearance of the skin on the client's legs is crucial as it can reveal additional signs of impaired circulation, such as changes in color, temperature, and the presence of ulcers or wounds. This information aids in the comprehensive evaluation of the client's vascular status and guides appropriate interventions to prevent potential complications.

5. The charge nurse observes that a client with a nasogastric tube on low intermittent suction is drinking a glass of water immediately after the unlicensed assistive personnel (UAP) left the room. What action should the nurse take?

• A. Remove the glass of water and speak to the UAP.
• B. Discuss the incident with the UAP at the end of the day.
• C. Write an incident report and notify the healthcare provider.
• D. Remind the client of the potential for electrolyte imbalance.

Correct answer: A

Rationale: The correct action for the charge nurse to take is to remove the glass of water and speak to the UAP. This ensures immediate correction and education to prevent further issues with the nasogastric tube. Addressing the situation promptly can prevent harm to the client and reinforces the importance of following proper protocols.

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