Nursing Elites

1. What is the primary cause of jaundice in a client with liver cirrhosis?

• A. Decreased bile production
• B. Increased bilirubin levels
• C. Hepatic inflammation
• D. Portal hypertension

Correct answer: B

Rationale: Jaundice in a client with liver cirrhosis is primarily caused by increased bilirubin levels. In liver cirrhosis, impaired liver function leads to the accumulation of bilirubin in the blood, resulting in jaundice. Bilirubin is a yellow pigment produced from the breakdown of red blood cells, and its elevation is a common manifestation of liver dysfunction. Choices A, C, and D are incorrect. While decreased bile production can contribute to jaundice, in liver cirrhosis, the key factor is the buildup of bilirubin due to liver dysfunction, not a decrease in bile production. Hepatic inflammation and portal hypertension are associated with liver cirrhosis but are not the primary causes of jaundice in this context.

2. A patient with chronic pain is prescribed a fentanyl patch. What is the most important instruction for the nurse to provide?

• A. Apply the patch to a different site each time.
• B. Change the patch every 72 hours.
• C. Avoid using additional heating pads over the patch.
• D. Remove the patch before showering.

Correct answer: B

Rationale: The most important instruction for the nurse to provide to a patient prescribed a fentanyl patch is to change the patch every 72 hours. This ensures consistent pain control and prevents complications. It is crucial to rotate the application sites to prevent skin irritation or reactions. Using additional heating pads over the patch should be avoided as it can increase the absorption of the medication, leading to overdose or adverse effects. Removing the patch before showering is not necessary as long as the patch is securely in place.

3. A patient is admitted with a diagnosis of myasthenia gravis. What symptom should the nurse expect to find during the assessment?

• A. Joint pain
• B. Muscle weakness
• C. Loss of sensation
• D. Severe headache

Correct answer: B

Rationale: Myasthenia gravis is a neuromuscular disorder characterized by muscle weakness and fatigue, especially in the voluntary muscles. Patients with myasthenia gravis commonly experience weakness in muscles that control eye movements, facial expressions, chewing, swallowing, and speaking. This weakness typically worsens with activity and improves with rest. Joint pain, loss of sensation, and severe headaches are not typical symptoms of myasthenia gravis. Therefore, the correct answer is muscle weakness (choice B) as it aligns with the characteristic symptom of myasthenia gravis.

4. A patient with schizophrenia is prescribed olanzapine. What is an important side effect for the healthcare provider to monitor?

• A. Hypertension
• B. Weight gain
• C. Hypoglycemia
• D. Bradycardia

Correct answer: B

Rationale: The correct answer is B: Weight gain. Olanzapine, an atypical antipsychotic, is known to cause significant weight gain and metabolic syndrome. It is crucial for healthcare providers to closely monitor patients for these side effects to prevent complications and provide appropriate interventions.

5. A 75-year-old patient is admitted for pancreatitis. Which tool would be the most appropriate for the nurse to use during the admission assessment?

• A. Drug Abuse Screening Test (DAST-10)
• B. Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)
• C. Screening Test-Geriatric Version (SMAST-G)
• D. Mini-Mental State Examination

Correct answer: C

Rationale: The most appropriate tool for the nurse to use during the admission assessment of a 75-year-old patient admitted for pancreatitis is the Screening Test-Geriatric Version (SMAST-G). Since alcohol abuse is a common factor associated with pancreatitis, screening for alcohol use is crucial. The SMAST-G is a validated short-form alcoholism screening instrument tailored for older adults. If the patient screens positively on the SMAST-G, then the CIWA-Ar would be useful for further assessment. The Drug Abuse Screening Test (DAST-10) provides information on substance use in general, not specific to alcohol. The Mini-Mental State Examination is used to assess cognitive function, not alcohol abuse.

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