Nursing Elites

1. A client with severe anemia is being treated with a blood transfusion. Which assessment finding indicates a transfusion reaction?

• A. Elevated blood pressure.
• B. Fever and chills.
• C. Increased urine output.
• D. Bradycardia.

Correct answer: B

Rationale: Fever and chills are classic signs of a transfusion reaction. These symptoms indicate that the body is having a response to the transfused blood, possibly due to incompatibility or an immune reaction. Elevated blood pressure (choice A) is not a typical sign of a transfusion reaction. Increased urine output (choice C) and bradycardia (choice D) are also not characteristic signs of a transfusion reaction. It is crucial to recognize symptoms of a transfusion reaction promptly to prevent further complications and ensure appropriate management.

2. A client with coronary artery disease (CAD) is prescribed atorvastatin (Lipitor). Which laboratory value requires immediate intervention?

• A. Total cholesterol of 180 mg/dL.
• B. Low-density lipoprotein (LDL) of 200 mg/dL.
• C. Triglycerides of 150 mg/dL.
• D. High-density lipoprotein (HDL) of 40 mg/dL.

Correct answer: B

Rationale: An LDL level of 200 mg/dL is significantly elevated and requires immediate intervention to reduce the risk of cardiovascular events in a client with coronary artery disease (CAD). High LDL levels contribute to the development and progression of atherosclerosis, which can lead to complications like heart attacks and strokes. Lowering LDL levels is a key goal in managing CAD and preventing further cardiovascular damage. Total cholesterol of 180 mg/dL, triglycerides of 150 mg/dL, and HDL of 40 mg/dL are within acceptable ranges and do not pose an immediate risk that necessitates urgent intervention.

3. A client has been diagnosed with an esophageal diverticulum after undergoing diagnostic imaging. When taking the health history, the nurse should expect the client to describe what sign or symptom?

• A. Burning pain on swallowing
• B. Regurgitation of undigested food
• C. Symptoms mimicking a myocardial infarction
• D. Chronic parotid abscesses

Correct answer: B

Rationale: Regurgitation of undigested food is a typical symptom of esophageal diverticulum. This condition forms a pouch in the esophagus that can trap food, leading to regurgitation of undigested food. The other options are not typically associated with esophageal diverticulum.

4. A healthcare professional is interested in studying the incidence of infant death in a particular city and wants to compare that city's rate to the state's rate. What state resource is most likely to provide this information?

• A. Disease registry.
• B. Department of Health.
• C. Bureau of Vital Statistics.
• D. Census data.

Correct answer: C

Rationale: The Bureau of Vital Statistics collects data on births and deaths, including infant mortality rates. This data is crucial for healthcare professionals to analyze and compare rates between different regions.

5. A 28-year-old woman at 34 weeks of gestation presents with elevated liver enzymes and pruritus. Labs reveal total bilirubin to be 4.2 mg/dL, AST 480 U/L, ALT 640 U/L, and alkaline phosphatase 232 U/L. Viral hepatitis serologies and ANA are negative. On physical examination, she is jaundiced, but has a normal blood pressure, no edema, and a soft abdomen. The fetus is in no distress. Which of the following is true?

• A. The baby should be delivered immediately
• B. Symptoms will resolve promptly after delivery
• C. There is little risk of recurrence with subsequent pregnancies
• D. The mother should be screened for long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency

Correct answer: B

Rationale: The patient's presentation is consistent with intrahepatic cholestasis of pregnancy (ICP), a condition characterized by elevated liver enzymes, pruritus, and jaundice in the absence of other liver disease causes. ICP typically resolves promptly after delivery. Immediate delivery is indicated only for fetal distress, not maternal symptoms. ICP does have a significant risk of recurrence in subsequent pregnancies. Treatment options for ICP include cholestyramine and ursodeoxycholic acid. Screening for long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency is not indicated in this context as it is associated with acute fatty liver of pregnancy and HELLP syndrome, not ICP.

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