Nursing Elites

1. A client with a history of alcoholism is admitted with pancreatitis. Which assessment finding is most important for the nurse to report to the healthcare provider?

• A. Nausea and vomiting.
• B. Epigastric pain radiating to the back.
• C. Temperature of 102°F (38.9°C).
• D. Mild jaundice.

Correct answer: C

Rationale: A temperature of 102°F (38.9°C) is the most important assessment finding to report to the healthcare provider in a client with pancreatitis and a history of alcoholism. Fever in this context can indicate infection, which is a serious complication requiring immediate intervention. Nausea and vomiting (choice A) are common symptoms of pancreatitis but may not require immediate intervention unless severe. Epigastric pain radiating to the back (choice B) is a classic symptom of pancreatitis and should be addressed, but a fever takes precedence. Mild jaundice (choice D) may be present in pancreatitis but is not as urgent as a high temperature signaling possible infection.

2. A client with a history of hypertension is prescribed enalapril (Vasotec). Which statement by the client indicates a need for further teaching?

• A. I will monitor my blood pressure regularly.
• B. I will report any signs of infection to my healthcare provider.
• C. I will avoid using salt substitutes.
• D. I will increase my intake of potassium-rich foods.

Correct answer: D

Rationale: The correct answer is D. Increasing potassium intake can lead to hyperkalemia, especially in clients taking ACE inhibitors like enalapril. Hyperkalemia is a potential side effect of ACE inhibitors and can be exacerbated by consuming potassium-rich foods. Monitoring blood pressure regularly (A) is important when taking antihypertensive medications. Reporting signs of infection (B) is crucial as ACE inhibitors can lower the immune response. Avoiding salt substitutes (C) is necessary because they may contain potassium chloride, leading to increased potassium levels, which can be harmful in combination with ACE inhibitors.

3. A community health nurse is planning an intervention to reduce the incidence of type 2 diabetes in the community. Which strategy is most effective?

• A. Hosting cooking classes on preparing healthy meals
• B. Offering free blood glucose screenings
• C. Distributing pamphlets on diabetes prevention
• D. Organizing a community walking program

Correct answer: A

Rationale: The most effective strategy to reduce the incidence of type 2 diabetes in the community is hosting cooking classes on preparing healthy meals. This intervention provides practical skills and education that can directly impact dietary habits, leading to a decreased risk of developing type 2 diabetes. Offering free blood glucose screenings (Choice B) may help in early detection but does not address prevention. Distributing pamphlets on diabetes prevention (Choice C) provides information but lacks the interactive and hands-on approach of cooking classes. Organizing a community walking program (Choice D) promotes physical activity, which is beneficial, but dietary changes have a more significant impact on preventing type 2 diabetes.

4. The client with liver cirrhosis needs immediate intervention for which abnormal laboratory result?

• A. Prothrombin time (PT) of 14 seconds.
• B. Bilirubin of 1.2 mg/dL.
• C. Albumin of 4 g/dL.
• D. Ammonia level of 80 mcg/dL.

Correct answer: D

Rationale: An elevated ammonia level of 80 mcg/dL indicates hepatic encephalopathy, a serious complication of liver cirrhosis that requires immediate intervention. Ammonia is a neurotoxin that accumulates in the blood due to impaired liver function, leading to cognitive impairment and altered mental status. Monitoring and lowering ammonia levels are crucial in managing hepatic encephalopathy to prevent further neurological deterioration. Prothrombin time, bilirubin, and albumin levels are important parameters in assessing liver function and overall health status in clients with liver cirrhosis, but an elevated ammonia level poses an immediate threat to neurological function and warrants prompt attention.

5. A community health nurse is evaluating the effectiveness of a diabetes management program. Which outcome indicates that the program is successful?

• A. increased attendance at diabetes education sessions
• B. reduced incidence of diabetes-related hospitalizations
• C. higher rates of blood glucose monitoring among participants
• D. greater knowledge of diabetes management techniques

Correct answer: B

Rationale: The correct answer is B: reduced incidence of diabetes-related hospitalizations. This outcome is a strong indicator of successful diabetes management, as it suggests that participants are effectively controlling their condition and experiencing fewer severe complications that require hospitalization. Increased attendance at education sessions (choice A) may not directly correlate with improved health outcomes. While higher rates of blood glucose monitoring (choice C) are important, they alone may not reflect overall program success. Greater knowledge of diabetes management techniques (choice D) is valuable but does not directly measure the impact of the program on health outcomes like reduced hospitalizations.

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