Nursing Elites

1. A client who participates in a health maintenance organization (HMO) needs a bone marrow transplant for the treatment of breast cancer. The client tells the nurse that she is concerned that her HMO may deny her claim. What action by the nurse best addresses the client's need at this time?

• A. Have the client's healthcare provider write a letter to the HMO explaining the need for the transplant.
• B. Help the client place a call to the HMO to seek information about limitations of coverage.
• C. Encourage the client to contact a lawyer to file a lawsuit against the HMO if necessary.
• D. Have the social worker contact the state board of insurance to register a complaint against the HMO.

Correct answer: B

Rationale: The best action for the nurse to take in this situation is to help the client directly contact the HMO to seek information about limitations of coverage. This approach addresses the client's immediate concerns and clarifies the situation, enabling the client to understand the coverage and potential outcomes regarding the bone marrow transplant. Choice A is not the best option as having the healthcare provider write a letter may not provide immediate clarification on coverage. Choice C is inappropriate as legal action should be considered as a last resort, and choice D involving the state board of insurance is not necessary at this initial stage of addressing the client's concern.

2. A 46-year-old man with a history of cirrhosis is brought in by his wife because he has been acting strangely. On examination, he is disoriented, ataxic, and has slurred speech. He is also hyperreflexic. His white blood cell count is normal. His hematocrit is 34%. Coagulation times are elevated. His ammonia level is normal. Which of the following statements regarding his management is correct?

• A. He should be treated with a low-protein diet and lactulose
• B. Lorazepam is not the drug of choice to control his behavior
• C. He should not be placed on gentamicin prophylactically to prevent the development of peritonitis
• D. If the patient complains of pain, acetaminophen should be avoided and nonsteroidal anti-inflammatory agents should be used

Correct answer: A

Rationale: This patient presents with symptoms consistent with hepatic encephalopathy. Despite having a normal ammonia level, he should be treated with lactulose and a low-protein diet as recommended for stage 2 hepatic encephalopathy. The normal ammonia level does not exclude the diagnosis, as it lacks sensitivity and specificity. Medications like lorazepam, gentamicin, and NSAIDs should be avoided due to their potential adverse effects in patients with liver disease. Acetaminophen should also be avoided in such patients.

3. A client is admitted with suspected meningitis. Which assessment finding requires immediate intervention?

• A. Headache.
• B. Fever.
• C. Nuchal rigidity.
• D. Seizures.

Correct answer: D

Rationale: Seizures in a client with suspected meningitis indicate increased intracranial pressure or other complications requiring immediate intervention. Seizures can lead to further neurological damage and need prompt management to prevent adverse outcomes. Therefore, addressing seizures promptly is crucial in the care of a client with suspected meningitis.

4. A 36-year-old woman complains of reflux symptoms and intermittent diarrhea. The diagnosis of gastrinoma is suspected so a fasting serum gastrin is obtained and found to be 280 pg/mL (normal <115 pg/mL). An abdominal CT is negative. What would you do now?

• A. Refer her for an exploratory laparotomy
• B. Measure serum gastrin in response to secretin infusion
• C. Treat her for H. pylori
• D. Obtain a dedicated small bowel series

Correct answer: B

Rationale: The next step after finding an elevated fasting serum gastrin level is to perform a secretin stimulation test. This test helps differentiate between gastrinoma and other causes of elevated gastrin levels, such as proton-pump inhibitor therapy or H2 antagonists. In gastrinoma, the serum gastrin level should further increase after secretin infusion, while in other conditions, the levels would not significantly rise. Exploratory laparotomy would be premature without confirming the diagnosis. Treating for H. pylori is not indicated as the diagnosis of gastrinoma is under consideration and not Helicobacter pylori infection. A dedicated small bowel series is not the next appropriate step in this scenario.

5. A client with a severe head injury is admitted to the intensive care unit (ICU). Which finding should the nurse report to the healthcare provider immediately?

• A. Urine output of 100 mL/hour.
• B. Intracranial pressure (ICP) of 20 mm Hg.
• C. Respiratory rate of 12 breaths/minute.
• D. Mean arterial pressure (MAP) of 70 mm Hg.

Correct answer: B

Rationale: An Intracranial Pressure (ICP) of 20 mm Hg is at the upper limit of normal and may indicate increased intracranial pressure, which is a critical finding in a client with a severe head injury. Elevated ICP can lead to further brain damage and must be addressed promptly to prevent complications such as herniation. Monitoring and managing ICP are crucial in the care of patients with head injuries in the ICU.

Similar Questions