Nursing Elites

1. What instruction should a patient with a history of hypertension be provided when being discharged with a prescription for a thiazide diuretic?

• A. Avoid foods high in potassium.
• B. Take the medication at bedtime.
• C. Monitor weight daily.
• D. Limit fluid intake to 1 liter per day.

Correct answer: C

Rationale: The correct instruction for a patient with a history of hypertension being discharged with a prescription for a thiazide diuretic is to monitor weight daily. This is important because thiazide diuretics can cause fluid imbalances, and monitoring weight daily can help detect significant changes early. Choice A, avoiding foods high in potassium, is not directly related to thiazide diuretics. Choice B, taking the medication at bedtime, may vary depending on the specific medication but is not a universal instruction. Choice D, limiting fluid intake to 1 liter per day, is not appropriate as adequate hydration is important to prevent complications like hypokalemia.

2. A 55-year-old man presents with jaundice, pruritus, and dark urine. Laboratory tests reveal elevated bilirubin and alkaline phosphatase. Imaging shows dilated intrahepatic bile ducts and a normal common bile duct. What is the most likely diagnosis?

• A. Primary biliary cirrhosis
• B. Primary sclerosing cholangitis
• C. Gallstones
• D. Pancreatic cancer

Correct answer: A

Rationale: The clinical presentation of jaundice, pruritus, dark urine, elevated bilirubin and alkaline phosphatase, along with imaging findings of dilated intrahepatic bile ducts and a normal common bile duct, are characteristic of primary biliary cirrhosis. Primary biliary cirrhosis is an autoimmune liver disease that leads to destruction of intrahepatic bile ducts, causing cholestasis and liver damage. This condition typically presents in middle-aged women but can also affect men, as seen in this case.

3. A client with myelogenous leukemia is receiving an autologous bone marrow transplantation (BMT). What is the priority intervention that the nurse should implement when the bone marrow is repopulating?

• A. Administer sargramostim (Leukine, Prokine).
• B. Infuse PRBC and platelet transfusions.
• C. Give parenteral prophylactic antibiotics.
• D. Maintain a protective isolation environment.

Correct answer: D

Rationale: Maintaining a protective isolation environment is crucial during the repopulation of bone marrow post-transplant to reduce the risk of infections. The client's immune system is compromised during this period, making them highly susceptible to infections. By implementing protective isolation measures, the nurse can help prevent exposure to pathogens, safeguarding the client's health and supporting the success of the transplantation.

4. A client from a nursing home is admitted with urinary sepsis and has a single-lumen, peripherally-inserted central catheter (PICC). Four medications are prescribed for 9:00 a.m. and the nurse is running behind schedule. Which medication should the nurse administer first?

• A. Piperacillin/tazobactam (Zosyn) in 100 ml D5W, IV over 30 minutes q8 hours.
• B. Vancomycin (Vancocin) 1 gm in 250 ml D5W, IV over 90 minutes q12 hours.
• C. Pantoprazole (Protonix) 40 mg PO daily.
• D. Enoxaparin (Lovenox) 40 mg subq q24 hours.

Correct answer: A

Rationale: In a patient with urinary sepsis, administering Piperacillin/tazobactam first is crucial as it is an antibiotic that directly targets the infection. Addressing the infection promptly is essential to prevent its progression and complications. Vancomycin, Pantoprazole, and Enoxaparin are important medications for the patient's overall treatment plan, but in this scenario, the antibiotic should take precedence due to the urgency of managing the sepsis.

5. Why is a low-protein diet recommended for a patient with renal failure?

• A. To prevent fluid overload
• B. To reduce nitrogenous waste
• C. To maintain electrolyte balance
• D. To prevent hyperglycemia

Correct answer: B

Rationale: A low-protein diet is crucial for patients with renal failure to reduce the generation of nitrogenous waste products like urea and creatinine, which the compromised kidneys struggle to eliminate effectively. By limiting protein intake, the production of these waste products is decreased, lessening the burden on the kidneys and helping to manage the progression of renal failure. Choices A, C, and D are incorrect because a low-protein diet primarily aims to reduce the workload on the kidneys by decreasing the production of nitrogenous waste, not to prevent fluid overload, maintain electrolyte balance, or prevent hyperglycemia.

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