Nursing Elites

1. A client is undergoing chemotherapy and is at risk for developing thrombocytopenia. What precaution should the nurse teach the client to minimize the risk of bleeding?

• A. Use a soft-bristled toothbrush.
• B. Engage in daily aerobic exercise.
• C. Take aspirin for headaches.
• D. Use an electric razor for shaving.

Correct answer: A

Rationale: Using a soft-bristled toothbrush is essential for clients at risk of thrombocytopenia to prevent gum bleeding, as their platelet counts may be low. Vigorous brushing with a hard-bristled toothbrush can injure the gums, leading to bleeding, which can be exacerbated in clients with low platelets. Therefore, advising the client to use a soft-bristled toothbrush is a crucial precaution to minimize the risk of bleeding.

2. A client is admitted with a diagnosis of acute pancreatitis. Which laboratory value should the nurse monitor closely?

• A. Serum amylase.
• B. Serum sodium.
• C. Serum calcium.
• D. Serum potassium.

Correct answer: A

Rationale: In acute pancreatitis, serum amylase is a crucial laboratory value to monitor closely. Elevated levels of serum amylase are a key indicator of pancreatic inflammation and can help confirm the diagnosis of acute pancreatitis. Therefore, monitoring serum amylase levels is essential for assessing the progression and severity of the condition in a client with acute pancreatitis.

3. The nurse is caring for a client with a history of deep vein thrombosis (DVT) who is receiving warfarin (Coumadin). Which laboratory value should the nurse monitor closely?

• A. Platelet count.
• B. Prothrombin time (PT).
• C. Hemoglobin level.
• D. White blood cell count.

Correct answer: B

Rationale: Prothrombin time (PT) is monitored to ensure therapeutic levels of warfarin and prevent bleeding complications.

4. A 28-year-old woman at 34 weeks of gestation presents with elevated liver enzymes and pruritus. Labs reveal total bilirubin to be 4.2 mg/dL, AST 480 U/L, ALT 640 U/L, and alkaline phosphatase 232 U/L. Viral hepatitis serologies and ANA are negative. On physical examination, she is jaundiced, but has a normal blood pressure, no edema, and a soft abdomen. The fetus is in no distress. Which of the following is true?

• A. The baby should be delivered immediately
• B. Symptoms will resolve promptly after delivery
• C. There is little risk of recurrence with subsequent pregnancies
• D. The mother should be screened for long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency

Correct answer: B

Rationale: The patient's presentation is consistent with intrahepatic cholestasis of pregnancy (ICP), a condition characterized by elevated liver enzymes, pruritus, and jaundice in the absence of other liver disease causes. ICP typically resolves promptly after delivery. Immediate delivery is indicated only for fetal distress, not maternal symptoms. ICP does have a significant risk of recurrence in subsequent pregnancies. Treatment options for ICP include cholestyramine and ursodeoxycholic acid. Screening for long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency is not indicated in this context as it is associated with acute fatty liver of pregnancy and HELLP syndrome, not ICP.

5. A 50-year-old man presents with fatigue, arthralgia, and darkening of the skin. Laboratory tests reveal elevated liver enzymes and high serum ferritin levels. What is the most likely diagnosis?

• A. Wilson's disease
• B. Hemochromatosis
• C. Alpha-1 antitrypsin deficiency
• D. Autoimmune hepatitis

Correct answer: B

Rationale: The symptoms of fatigue, arthralgia, and skin darkening, along with elevated liver enzymes and high serum ferritin levels, are characteristic of hemochromatosis, a condition characterized by iron overload. In hemochromatosis, excess iron is deposited in various organs, including the liver, leading to symptoms such as fatigue, joint pain, and skin pigmentation changes. The elevated liver enzymes and high serum ferritin levels seen in this patient further support the diagnosis of hemochromatosis.

Similar Questions