Nursing Elites

1. A patient is admitted to the same-day surgery unit for a liver biopsy. Which of the following laboratory tests assesses coagulation? Select one that doesn't apply.

• A. Partial thromboplastin time
• B. Prothrombin time
• C. Platelet count
• D. Hemoglobin

Correct answer: D

Rationale: The correct answer is 'Hemoglobin.' Hemoglobin levels are not indicative of coagulation status but are important for assessing oxygen-carrying capacity. Choices A, B, and C are all laboratory tests that assess coagulation. Partial thromboplastin time (PTT) and prothrombin time (PT) evaluate different aspects of the coagulation cascade, while platelet count is essential for assessing primary hemostasis. Therefore, in the context of evaluating coagulation, hemoglobin is not the appropriate choice.

2. Which finding would necessitate an immediate change in the therapeutic plan for a patient with grade 2 hepatic encephalopathy?

• A. Weight loss of 2 lb (1 kg)
• B. Positive urine pregnancy test
• C. Hemoglobin level of 10.4 g/dL
• D. Complaints of nausea and anorexia

Correct answer: B

Rationale: A positive urine pregnancy test would require an immediate change in the therapeutic plan for a patient with grade 2 hepatic encephalopathy due to the teratogenic effects of ribavirin. Ribavirin needs to be discontinued immediately to prevent harm to the fetus. The other options, weight loss, hemoglobin level, and complaints of nausea and anorexia, are common adverse effects of the prescribed regimen and may necessitate interventions such as patient education or supportive care, but they would not mandate an immediate cessation of therapy as in the case of a positive pregnancy test.

3. Which clinical manifestations are recognized in nephrotic syndrome?

• A. Hematuria, bacteriuria, weight gain
• B. Gross hematuria, albuminuria, fever
• C. Hypertension, weight loss, proteinuria
• D. Massive proteinuria, hypoalbuminemia, edema

Correct answer: D

Rationale: Nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia, and edema. In this syndrome, there is loss of proteins, particularly albumin, in the urine leading to hypoalbuminemia, fluid retention, and subsequent edema. This results in elevated lipid levels like hypercholesterolemia, but not hypertension. Therefore, choices A, B, and C are incorrect. Hematuria, bacteriuria, fever, and weight loss are not typically associated with nephrotic syndrome, distinguishing it from other kidney disorders.

4. A 49-year-old female patient with cirrhosis and esophageal varices has a new prescription for propranolol (Inderal). Which finding is the best indicator that the medication has been effective?

• A. The patient reports no chest pain.
• B. Blood pressure is 140/90 mm Hg
• C. Stools test negative for occult blood.
• D. The apical pulse rate is 68 beats/minute.

Correct answer: C

Rationale: The best indicator that propranolol has been effective in a patient with cirrhosis and esophageal varices is when the stools test negative for occult blood. Propranolol is prescribed to decrease the risk of bleeding from esophageal varices. This medication's effectiveness is primarily assessed by the absence of blood in the stools, indicating a reduction in the risk of bleeding from the varices. Monitoring for chest pain, blood pressure control, and a decrease in heart rate are important parameters in other conditions treated with propranolol, such as hypertension, angina, and tachycardia, but in this particular case, the absence of occult blood in the stools is the most relevant indicator of treatment success.

5. The nursing care plan for a toddler diagnosed with Kawasaki Disease (mucocutaneous lymph node syndrome) should be based on the high risk for development of which problem?

• A. Chronic vessel plaque formation
• B. Pulmonary embolism
• C. Occlusions at the vessel bifurcations
• D. Coronary artery aneurysms

Correct answer: A

Rationale: The correct answer is chronic vessel plaque formation. Kawasaki Disease affects small and medium-sized blood vessels, leading to progressive inflammation and potential damage to the walls of medium-sized muscular arteries, which can result in coronary artery aneurysms. While other complications such as pulmonary embolism and occlusions at vessel bifurcations can occur in different conditions, for Kawasaki Disease, the primary concern is the development of chronic vessel plaque formation.

Similar Questions