Nursing Elites

1. 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.

2. While assessing a 70-year-old female client with Alzheimer's disease, the nurse notes deep inflamed cracks at the corners of her mouth. What intervention should the nurse include in this client's plan of care?

• A. Apply a moisturizing cream to the affected areas.
• B. Encourage the client to consume foods rich in vitamin B.
• C. Notify the healthcare provider for further evaluation.
• D. Ensure that the client gets adequate B vitamins in foods or supplements.

Correct answer: D

Rationale: Cracks at the corners of the mouth, known as angular cheilitis, can be a sign of vitamin B deficiency, specifically B2 (riboflavin) or B3 (niacin). The nurse should ensure that the client receives adequate B vitamins through foods rich in these nutrients or supplements to address the deficiency, which can help improve the condition of the client's mouth.

3. A client with a newly created ileostomy has not had ostomy output for the past 12 hours and reports worsening nausea. What is the nurse's priority action?

• A. Facilitate a referral to the wound-ostomy-continence (WOC) nurse
• B. Report signs and symptoms of obstruction to the health care provider
• C. Encourage the client to mobilize to enhance mobility
• D. Contact the health care provider to obtain a swab of the stoma for culture

Correct answer: B

Rationale: The nurse's priority action in this situation is to report signs and symptoms of possible obstruction to the healthcare provider. Lack of ostomy output and worsening nausea can indicate a potential obstruction, which requires immediate attention and intervention to prevent complications.

4. Which problem in a client requires the most immediate intervention by the nurse?

• A. Finger paresthesias related to carpal tunnel syndrome.
• B. Increasing sharp pain related to compartment syndrome.
• C. Increasing burning pain related to a Morton's neuroma.
• D. Increasing sharp pain related to plantar fasciitis.

Correct answer: B

Rationale: The correct answer is B: Increasing sharp pain related to compartment syndrome. Compartment syndrome is a serious condition where increased pressure within a muscle compartment compromises circulation and can lead to tissue damage. Immediate intervention is crucial to prevent permanent damage to muscles and nerves, including tissue necrosis and nerve injury. Choices A, C, and D do not present the same level of urgency as compartment syndrome, making them less critical for immediate intervention. Carpal tunnel syndrome, Morton's neuroma, and plantar fasciitis may cause discomfort and functional limitations but are not typically considered emergencies requiring urgent intervention like compartment syndrome.

5. A 45-year-old obese man arrives at a clinic reporting daytime sleepiness, difficulty falling asleep at night, and snoring. The nurse should recognize the manifestations of what health problem?

• A. Adenoiditis
• B. Chronic tonsillitis
• C. Obstructive sleep apnea
• D. Laryngeal cancer

Correct answer: C

Rationale: The symptoms described, including daytime sleepiness, difficulty falling asleep at night, and snoring, are classic signs of obstructive sleep apnea. This condition is commonly seen in obese individuals due to the relaxation of throat muscles during sleep, leading to airway obstruction. Adenoiditis and chronic tonsillitis are less likely as they don't typically present with the same symptoms mentioned.

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