Nursing Elites

1. A client with liver cirrhosis is being educated about managing their condition. Which statement by the client indicates a need for further teaching?

• A. I will avoid drinking alcohol
• B. I need to limit my salt intake
• C. I can take acetaminophen for pain
• D. I should eat a balanced diet

Correct answer: C

Rationale: The correct answer is C. Clients with liver cirrhosis should avoid acetaminophen because it can cause further liver damage. Acetaminophen is metabolized in the liver, and in individuals with liver disease, it can lead to liver toxicity. Therefore, clients with liver cirrhosis should use alternative pain medications that do not affect the liver, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids as prescribed by their healthcare provider. Choices A, B, and D are correct statements for managing liver cirrhosis. Avoiding alcohol helps prevent further liver damage, limiting salt intake helps manage fluid retention and complications like ascites, and eating a balanced diet supports overall health and helps prevent malnutrition.

2. The healthcare provider in the outpatient clinic has obtained health histories for these new patients. Which patient may need referral for genetic testing?

• A. 35-year-old patient whose maternal grandparents died after strokes at ages 90 and 96
• B. 18-year-old patient with a positive pregnancy test whose first child has cerebral palsy
• C. 34-year-old patient who has a sibling with newly diagnosed polycystic kidney disease
• D. 50-year-old patient with a history of cigarette smoking who is complaining of dyspnea

Correct answer: C

Rationale: The 34-year-old patient who has a sibling with newly diagnosed polycystic kidney disease may need referral for genetic testing. Polycystic kidney disease is an autosomal dominant disorder that can be asymptomatic until later in life. Presymptomatic testing can provide valuable information for guiding lifestyle and family planning decisions. The other patients do not present indications for genetic testing based on the information provided in their health histories. The 35-year-old patient's maternal grandparents' strokes are not indicative of a need for genetic testing. The 18-year-old patient's child having cerebral palsy is not a direct indication for genetic testing of the patient herself. The 50-year-old patient's symptoms are more likely related to smoking and respiratory issues, not genetic predisposition to a specific disease.

3. A 70-year-old woman presents with fatigue, anorexia, and weight loss. She has noticed darkening of her skin, particularly in sun-exposed areas. Laboratory tests reveal hyponatremia, hyperkalemia, and low cortisol levels. What is the most likely diagnosis?

• A. Cushing's syndrome
• B. Addison's disease
• C. Hypothyroidism
• D. Pheochromocytoma

Correct answer: B

Rationale: The combination of symptoms such as fatigue, anorexia, weight loss, hyperpigmentation of the skin, along with hyponatremia, hyperkalemia, and low cortisol levels, points towards Addison's disease. This condition is characterized by adrenal insufficiency, leading to a deficiency in cortisol and aldosterone production.

4. The healthcare provider formulates a nursing diagnosis of 'High risk for ineffective airway clearance' for a client with myasthenia gravis. What is the most likely cause for this nursing diagnosis?

• A. Pain during coughing.
• B. Diminished cough effort.
• C. Thick, dry secretions.
• D. Excessive inflammation.

Correct answer: B

Rationale: Clients with myasthenia gravis commonly experience muscle weakness, including in the muscles used for coughing. This diminished cough effort can lead to ineffective airway clearance, increasing the risk of respiratory complications. Therefore, the most likely cause for the nursing diagnosis 'High risk for ineffective airway clearance' in a client with myasthenia gravis is the diminished cough effort due to muscle weakness.

5. 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.

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