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 client who delivered a 7-pound infant 12 hours ago is complaining of a severe headache. The client's blood pressure is 110/70, respiratory rate is 18 breaths/minute, heart rate is 74 beats/minute, and temperature is 98.6º F. The client's fundus is firm and one fingerbreadth above the umbilicus. What action should the healthcare team implement first?

• A. Notify the healthcare provider of the assessment findings.
• B. Determine if the client received anesthesia during delivery.
• C. Assign a licensed nurse to reassess the client's vital signs.
• D. Obtain a STAT hemoglobin and hematocrit.

Correct answer: B

Rationale: The correct action to implement first is to determine if the client received anesthesia during delivery. Anesthesia can be a potential cause of postpartum headaches. This information is crucial in assessing and managing the client's condition effectively before considering other interventions. It helps in identifying possible contributing factors to the client's complaint of a severe headache and guides the healthcare team in providing appropriate care and treatment.

3. A patient with chronic heart failure is prescribed furosemide. What is the primary action of this medication?

• A. Increase cardiac output
• B. Reduce fluid retention
• C. Decrease heart rate
• D. Lower blood pressure

Correct answer: B

Rationale: Furosemide is a loop diuretic that acts by inhibiting sodium and chloride reabsorption in the loop of Henle, leading to increased diuresis. By reducing fluid retention, furosemide helps decrease the workload on the heart in patients with chronic heart failure. This medication does not directly increase cardiac output, decrease heart rate, or lower blood pressure as its primary action.

4. The healthcare provider prescribes naproxen (Naprosyn) 500 mg PO twice a day for a client with osteoarthritis. During a follow-up visit one month later, the client tells the nurse, 'The pills don't seem to be working. They are not helping the pain at all.' Which factor should influence the nurse's response?

• A. Noncompliance is probably affecting optimal medication effectiveness.
• B. Drug dosage is inadequate and needs to be increased to three times a day.
• C. The drug needs 4 to 6 weeks to reach therapeutic levels in the bloodstream.
• D. NSAID response is variable, and trying another NSAID may be more effective.

Correct answer: D

Rationale: Different NSAIDs work differently in individuals. If a patient is not experiencing relief with one NSAID, switching to a different one may provide better pain management. This variability in response is common among NSAIDs due to individual differences in drug metabolism and efficacy.

5. A client is on a mechanical ventilator. Which client response indicates that the neuromuscular blocker tubocurarine chloride (Tubarine) is effective?

• A. The client's extremities are paralyzed.
• B. The peripheral nerve stimulator causes twitching.
• C. The client clenches fist upon command.
• D. The client's Glasgow Coma Scale score is 14.

Correct answer: A

Rationale: The correct answer is A. Tubocurarine chloride is a neuromuscular blocker that works by causing paralysis of skeletal muscles. Therefore, if the client's extremities are paralyzed, it indicates that the medication is effective in achieving the desired muscle relaxation necessary for mechanical ventilation. Choices B and C are incorrect as they suggest muscle activity, which would not be expected with the administration of a neuromuscular blocker. Choice D is unrelated to the effectiveness of tubocurarine chloride.

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