Nursing Elites

1. A client's telemetry monitor indicates the sudden onset of ventricular fibrillation. Which assessment finding should the nurse anticipate?

• A. Bounding erratic pulse.
• B. Regularly irregular pulse.
• C. Thready irregular pulse.
• D. No palpable pulse.

Correct answer: D

Rationale: Ventricular fibrillation is a life-threatening arrhythmia characterized by chaotic, asynchronous contractions of the ventricles, resulting in ineffective cardiac output. This leads to the absence of a palpable pulse. Nurses should be prepared to initiate immediate interventions such as defibrillation to restore normal cardiac rhythm in a client experiencing ventricular fibrillation.

2. The nurse is administering sevelamer (RenaGel) during lunch to a client with end-stage renal disease (ESRD). The client asks the nurse to bring the medication later. The nurse should describe which action of RenaGel as an explanation for taking it with meals?

• A. Prevents indigestion associated with the ingestion of spicy foods.
• B. Binds with phosphorus in foods and prevents absorption.
• C. Promotes stomach emptying and prevents gastric reflux.
• D. Buffers hydrochloric acid and prevents gastric erosion.

Correct answer: B

Rationale: Sevelamer (RenaGel) binds with phosphorus in foods to prevent its absorption, which is why it should be taken with meals. By taking RenaGel with meals, it can effectively bind with phosphorus from food, reducing the amount of phosphorus absorbed by the body, thus helping to manage hyperphosphatemia in clients with ESRD. Choices A, C, and D are incorrect because RenaGel's primary action is to bind with phosphorus in foods, not related to preventing indigestion, promoting stomach emptying, or buffering hydrochloric acid.

3. The sister of a patient diagnosed with BRCA gene-related breast cancer asks the nurse, 'Do you think I should be tested for the gene?' Which response by the nurse is most appropriate?

• A. In most cases, breast cancer is not caused by the BRCA gene.
• B. It depends on how you will feel if the test is positive for the BRCA gene.
• C. There are many things to consider before deciding to have genetic testing.
• D. You should decide first whether you are willing to have a bilateral mastectomy.

Correct answer: C

Rationale: The most appropriate response by the nurse is C: 'There are many things to consider before deciding to have genetic testing.' Genetic testing for BRCA gene mutations is a complex decision that involves various factors such as emotional readiness, potential impact on insurance and employability, and the implications of test results. Option A is incorrect because although most breast cancers are not related to BRCA gene mutations, individuals with these mutations have a significantly higher risk. Option B is not ideal as it oversimplifies the decision-making process by focusing solely on emotional aspects. Option D is incorrect as it implies a predetermined course of action (mastectomy) before even undergoing genetic testing, which is not appropriate.

4. An 82-year-old woman with no past medical history presents to your clinic complaining of arthritic symptoms. She is not taking any medications but needs something for her arthritis. You want to start her on a nonsteroidal anti-inflammatory drug (NSAID) but are concerned about her age and the risk of peptic ulcers. As she has to pay for her medications out-of-pocket and requests the most cost-effective option, what is the most appropriate treatment plan?

• A. Prescribe an inexpensive NSAID alone
• B. Prescribe an inexpensive NSAID and misoprostol
• C. Prescribe celecoxib
• D. Prescribe an inexpensive NSAID and sucralfate

Correct answer: A

Rationale: In this scenario, the most appropriate treatment plan would be to prescribe an inexpensive NSAID alone. While the elderly woman is at a higher risk of developing NSAID-related toxicity, prophylaxis with misoprostol or sucralfate is not recommended in the absence of a history of peptic ulcer disease or abdominal symptoms. Celecoxib, a selective COX-2 inhibitor, may be a more expensive option than traditional NSAIDs. Considering the patient's preference for the most inexpensive option and the lack of specific risk factors, starting with a standalone NSAID is the most suitable approach.

5. What nursing intervention can help alleviate pruritus in a client with cirrhosis?

• A. Administering antihistamines
• B. Providing a high-protein diet
• C. Applying emollients to the skin
• D. Encouraging frequent baths with hot water

Correct answer: C

Rationale: Applying emollients to the skin can help alleviate pruritus in clients with cirrhosis. Emollients help soothe and moisturize the skin, reducing the discomfort associated with itching.

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