Nursing Elites

1. A 62-year-old male client with a history of coronary artery disease complains that his heart is 'racing' and he often feels dizzy. His blood pressure is 110/60, and he uses portable oxygen at 2 liters per nasal cannula. Based on the rhythm shown, which prescription should the nurse administer?

• A. Give magnesium via secondary infusion.
• B. Initiate IV heparin solution as per protocol.
• C. Administer IV adenosine (Adenocard).
• D. Prepare for synchronized cardioversion.

Correct answer: C

Rationale: Administering IV adenosine is the appropriate intervention for a client with symptomatic tachycardia to restore normal sinus rhythm. Adenosine is a medication used to treat supraventricular tachycardia (SVT) by interrupting the reentry pathways through the AV node and restoring normal sinus rhythm. It is a rapid-acting medication given as a rapid IV push followed by a saline flush. The dose is typically administered in a healthcare setting where cardiac monitoring is available due to its potential to cause transient asystole.

2. When assessing a client reporting severe pain in the right lower quadrant of the abdomen, which sign would most likely indicate appendicitis?

• A. Rebound tenderness at McBurney's point.
• B. Positive Murphy's sign.
• C. Rovsing's sign.
• D. Cullen's sign.

Correct answer: A

Rationale: Rebound tenderness at McBurney's point is a classic sign of appendicitis. This sign indicates peritoneal irritation, a common feature of appendicitis. McBurney's point is located in the right lower quadrant of the abdomen and is a focal point for assessing tenderness. Positive Murphy's sign is associated with cholecystitis, not appendicitis. Rovsing's sign is elicited by palpation of the left lower quadrant resulting in pain in the right lower quadrant, also suggestive of appendicitis. Cullen's sign is associated with acute pancreatitis and manifests as periumbilical ecchymosis.

3. The client has been prescribed metformin (Glucophage) for type 2 diabetes. Which instruction should the nurse include in discharge teaching?

• A. Take the medication at bedtime.
• B. Take the medication with meals.
• C. Take the medication on an empty stomach.
• D. Take the medication as needed for high blood sugar.

Correct answer: B

Rationale: The correct instruction for taking metformin (Glucophage) is with meals. This helps reduce gastrointestinal side effects and improves the medication's absorption. Taking it on an empty stomach can lead to more adverse effects, so it is essential to take it with food. Option A ('Take the medication at bedtime') is incorrect because metformin should be taken with meals to enhance its effectiveness and reduce side effects. Option C ('Take the medication on an empty stomach') is incorrect as taking metformin on an empty stomach can increase the likelihood of experiencing gastrointestinal issues. Option D ('Take the medication as needed for high blood sugar') is incorrect because metformin is typically taken regularly as prescribed, not just as needed for high blood sugar.

4. A client with hepatic encephalopathy exhibits confusion, difficulty arousing from sleep, and rigid extremities. Based on these clinical findings, what stage of hepatic encephalopathy should the nurse document?

• A. Stage 1
• B. Stage 2
• C. Stage 3
• D. Stage 4

Correct answer: C

Rationale: Stage 3 hepatic encephalopathy is characterized by confusion, difficulty arousing from sleep, and rigidity of extremities. These symptoms indicate advanced manifestations of hepatic encephalopathy, requiring prompt intervention and monitoring to prevent further neurological deterioration.

5. A 35-year-old male patient presents with right upper quadrant pain, fever for the past 48 hours, preceded by new onset jaundice over the past few weeks. He states that he has had diarrhea on and off for several years but never had this investigated. A liver ultrasound is negative for gallstones or evidence of cholecystitis. His lab tests reveal total bilirubin 6.2, alkaline phosphatase 450, AST 150, ALT 120, albumin 2.6. The next diagnostic test of choice would be

• A. Liver biopsy
• B. Magnetic resonance cholangiopancreatography
• C. Hepatitis B surface antigen and hepatitis C RNA assay
• D. Colonoscopy with biopsies

Correct answer: B

Rationale: The patient's presentation with right upper quadrant pain, fever, and jaundice, along with abnormal liver function tests, suggests a biliary tract problem. Given the suspicion of obstructed bile flow and the negative liver ultrasound for gallstones, magnetic resonance cholangiopancreatography (MRCP) is the next appropriate step to evaluate the biliary system and pancreatic ducts. MRCP is non-invasive and can provide detailed images for diagnosis. Liver biopsy is not the preferred initial diagnostic test in this context. Testing for hepatitis B and C would not address the current clinical scenario, and colonoscopy is not indicated for the presenting symptoms.

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