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 community mental health nurse is planning to visit four clients with schizophrenia today. Which client should the nurse see first?

• A. The mother who took her children from school because aliens were after them.
• B. The young man who has a history of substance abuse and no telephone.
• C. The newly diagnosed client who needs to be evaluated for medication compliance.
• D. The young woman who believes she is to blame for her recent miscarriage.

Correct answer: A

Rationale: The mother who took her children from school due to delusions of aliens poses a significant risk to her children and herself. This situation requires immediate attention to ensure the safety and well-being of all involved. Choice B is concerning due to the history of substance abuse, but the immediate risk to life and safety as in Choice A takes precedence. Choice C, although important, does not present an immediate danger as the delusional belief of aliens. Choice D, while emotionally distressing, does not pose an immediate threat as the situation described in Choice A.

3. A patient with type 2 diabetes is prescribed metformin. What instruction should the nurse provide regarding this medication?

• A. Take the medication on an empty stomach.
• B. Monitor for signs of hypoglycemia.
• C. Take the medication with meals.
• D. Increase intake of simple carbohydrates.

Correct answer: C

Rationale: The correct instruction for a patient prescribed metformin is to take the medication with meals. This helps reduce gastrointestinal side effects commonly associated with metformin. Patients should also be educated about the signs of lactic acidosis, a rare but serious side effect associated with metformin use.

4. A 65-year-old man presents with weight loss, jaundice, and a palpable mass in the right upper quadrant. Laboratory tests reveal elevated bilirubin and alkaline phosphatase levels. What is the most likely diagnosis?

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

Correct answer: C

Rationale: The combination of weight loss, jaundice, a palpable mass in the right upper quadrant, and elevated bilirubin and alkaline phosphatase levels strongly suggests pancreatic cancer. The presentation is classic for pancreatic malignancy, which commonly presents with obstructive jaundice due to the tumor blocking the common bile duct, leading to elevated bilirubin and alkaline phosphatase levels. Weight loss is a common symptom of advanced pancreatic cancer. The palpable mass in the right upper quadrant corresponds to the location of the pancreas. Gallstones typically manifest with different symptoms, while hepatitis and primary biliary cirrhosis are less likely to present with a palpable mass and weight loss in this scenario.

5. A client with chronic renal failure is prescribed erythropoietin (Epogen). Which outcome indicates that the medication is effective?

• A. Increased urine output.
• B. Improved hemoglobin levels.
• C. Decreased blood pressure.
• D. Stable potassium levels.

Correct answer: B

Rationale: The correct answer is B: Improved hemoglobin levels. Erythropoietin (Epogen) stimulates red blood cell production, leading to an increase in hemoglobin levels in clients with chronic renal failure. Monitoring hemoglobin levels is crucial to assess the effectiveness of erythropoietin therapy in managing anemia associated with chronic renal failure. While increased urine output, decreased blood pressure, and stable potassium levels are important parameters to monitor in clients with renal failure, they are not direct indicators of the effectiveness of erythropoietin therapy.

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