Nursing Elites

1. After a client with ascites due to liver cirrhosis undergoes a paracentesis, what should the nurse do post-procedure?

• A. Encourage the client to drink plenty of fluids
• B. Monitor the client's blood pressure and heart rate
• C. Position the client flat on their back
• D. Administer a dose of furosemide

Correct answer: B

Rationale: Post-paracentesis, monitoring the client's blood pressure and heart rate is crucial as it helps in early detection of potential complications such as hypotension or bleeding. This close observation enables timely intervention and ensures the client's safety.

2. A client with cirrhosis is at risk for bleeding. Which laboratory test is most important to monitor?

• A. Blood glucose
• B. Serum creatinine
• C. Prothrombin time (PT)
• D. Electrolytes

Correct answer: C

Rationale: In clients with cirrhosis, monitoring the Prothrombin time (PT) is crucial as it assesses the blood's ability to clot. Cirrhosis can lead to impaired liver function, affecting the synthesis of clotting factors, hence increasing the risk of bleeding. Maintaining a close watch on PT levels helps in timely intervention to prevent excessive bleeding episodes. Blood glucose (Choice A) is not directly related to the clotting function; serum creatinine (Choice B) and electrolytes (Choice D) are important, but in cirrhosis, monitoring PT takes precedence due to the increased bleeding risk.

3. A 35-year-old man presents with fatigue, weight loss, and hyperpigmentation of the skin. Laboratory tests reveal hyponatremia, hyperkalemia, and low cortisol levels. What is the most likely diagnosis?

• A. Cushing's syndrome
• B. Addison's disease
• C. Hypothyroidism
• D. Pheochromocytoma

Correct answer: B

Rationale: The clinical presentation of a 35-year-old man with fatigue, weight loss, hyperpigmentation of the skin, hyponatremia, hyperkalemia, and low cortisol levels is classic for Addison's disease. These findings are consistent with primary adrenal insufficiency, where the adrenal glands fail to produce adequate cortisol. In Addison's disease, the adrenal cortex is damaged, leading to decreased cortisol production and elevated levels of ACTH. This results in symptoms such as fatigue, weight loss, and hyperpigmentation due to increased ACTH production stimulating melanocytes. Hyponatremia and hyperkalemia are common electrolyte abnormalities seen in Addison's disease due to aldosterone deficiency. Therefore, the correct diagnosis in this case is Addison's disease.

4. The nurse is planning care for a 16-year-old with juvenile rheumatoid arthritis (JRA). The nurse includes activities to strengthen and mobilize the joints and surrounding muscles. Which physical therapy regimen should the nurse encourage the adolescent to implement?

• A. Exercise in a swimming pool.
• B. Splint affected joints during activity.
• C. Perform passive range of motion exercises twice daily.
• D. Begin a training program of lifting weights and running.

Correct answer: A

Rationale: Exercising in a swimming pool is beneficial for adolescents with juvenile rheumatoid arthritis as it reduces stress on the joints while allowing movement and strengthening. The buoyancy of water supports the body, making exercises easier and less painful, while also providing resistance to strengthen muscles. This form of exercise can help improve joint mobility and overall function without causing excessive strain on the joints. Choices B, C, and D are incorrect because splinting affected joints, performing passive range of motion exercises, or beginning a training program of lifting weights and running can potentially exacerbate symptoms and cause additional stress on the joints, which is not recommended for individuals with juvenile rheumatoid arthritis.

5. 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.

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