Nursing Elites

1. A healthcare professional is reviewing the results of serum laboratory studies of a client with suspected hepatitis. Which increased parameter is interpreted as the most specific indicator of this disease?

• A. Hemoglobin
• B. Serum bilirubin
• C. Blood urea nitrogen (BUN)
• D. Erythrocyte sedimentation rate (ESR)

Correct answer: B

Rationale: Serum bilirubin is the most specific indicator of hepatitis as it reflects liver dysfunction. Hemoglobin, blood urea nitrogen (BUN), and erythrocyte sedimentation rate (ESR) are not specific to hepatitis. Hemoglobin measures the oxygen-carrying capacity of red blood cells, BUN evaluates kidney function, and ESR is a nonspecific marker of inflammation or infection.

2. In a patient with deep vein thrombosis (DVT), which of the following symptoms would be expected?

• A. Chest pain.
• B. Shortness of breath.
• C. Coughing up blood.
• D. Cyanosis.

Correct answer: B

Rationale: Shortness of breath is a common symptom of deep vein thrombosis (DVT) due to the risk of a pulmonary embolism. DVT occurs when a blood clot forms in a deep vein, usually in the legs. If a portion of the clot breaks loose and travels to the lungs, it can cause a pulmonary embolism, leading to symptoms like shortness of breath. Chest pain is more commonly associated with conditions like a heart attack or pulmonary embolism itself. Coughing up blood is a symptom more indicative of conditions such as pulmonary embolism or lung cancer. Cyanosis, which is a bluish discoloration of the skin or mucous membranes due to poor oxygenation, can be seen in severe cases of pulmonary embolism but is not a typical symptom of DVT.

3. The nurse is obtaining the admission history for a client with suspected peptic ulcer disease (PUD). Which subjective data reported by the client supports this diagnosis?

• A. Frequent use of chewable and liquid antacids for indigestion
• B. Severe abdominal cramps and diarrhea after eating spicy foods
• C. Upper mid-abdominal gnawing and burning pain
• D. Marked weight loss and appetite over the last 3 to 4 months

Correct answer: C

Rationale: The correct answer is C: 'Upper mid-abdominal gnawing and burning pain.' This symptom is a classic presentation of peptic ulcer disease. Antacids (choice A) may provide relief but do not confirm the diagnosis. Severe abdominal cramps and diarrhea (choice B) are more suggestive of other conditions like irritable bowel syndrome. Weight loss and appetite changes (choice D) are non-specific and could be related to various health issues.

4. The patient will begin taking doxycycline to treat an infection. When should the nurse plan to give this medication?

• A. 1 hour before or 2 hours after a meal.
• B. with an antacid to minimize GI irritation.
• C. with food to improve absorption.
• D. with small sips of water.

Correct answer: C

Rationale: Doxycycline is a lipid-soluble tetracycline that is better absorbed when taken with milk products and food. Taking doxycycline with food helps improve its absorption. It should not be taken on an empty stomach, as this can decrease its effectiveness. Antacids can interfere with the absorption of tetracyclines, so they should not be taken together. While it is important to stay hydrated when taking medications, small sips of water are not specifically recommended for doxycycline administration.

5. A client with early breast cancer receives the results of a breast biopsy and asks the nurse to explain the meaning of staging and the type of receptors found on the cancer cells. Which explanation should the nurse provide?

• A. Lymph node involvement is not significant.
• B. Small tumors are aggressive and indicate poor prognosis.
• C. The tumor's estrogen receptor guides treatment options.
• D. Stage I indicates metastasis.

Correct answer: C

Rationale: Treatment decisions and prediction of prognosis are related to the tumor's receptor status, such as estrogen and progesterone receptor status which commonly are well-differentiated, have a lower chance of recurrence, and are receptive to hormonal therapy. Tumor staging designates tumor size and spread of breast cancer cells into axillary lymph nodes, which is one of the most important prognostic factors in early-stage breast cancer.

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