Nursing Elites

1. A patient with cirrhosis of the liver and ascites is scheduled for a paracentesis. What should the nurse do to prepare the patient for the procedure?

• A. Have the patient void immediately before the procedure.
• B. Position the patient upright or semi-Fowler's in bed.
• C. Administer a full liquid diet.
• D. Encourage the patient to ambulate for 30 minutes.

Correct answer: A

Rationale: The correct preparation for a paracentesis in a patient with cirrhosis and ascites includes having the patient void immediately before the procedure. This is important to reduce the risk of bladder puncture during the paracentesis. Positioning for a paracentesis is typically upright or semi-Fowler's, not flat in bed. Administering a full liquid diet or encouraging ambulation for 30 minutes are not directly related to preparing a patient for a paracentesis procedure.

2. A 35-year-old man presents with difficulty swallowing, weight loss, and regurgitation of undigested food. A barium swallow shows a 'bird beak' appearance of the lower esophagus. What is the most likely diagnosis?

• A. Esophageal cancer
• B. Achalasia
• C. Peptic stricture
• D. Gastroesophageal reflux disease

Correct answer: B

Rationale: The 'bird beak' appearance on a barium swallow is characteristic of achalasia, a condition where the lower esophageal sphincter fails to relax properly. This leads to difficulty swallowing, weight loss, and regurgitation of undigested food, which are hallmark symptoms of achalasia.

3. A client with liver cirrhosis and ascites is being treated with spironolactone. What is a key nursing consideration for this medication?

• A. Monitoring for signs of hyperkalemia
• B. Checking for signs of hypoglycemia
• C. Assessing for signs of dehydration
• D. Observing for symptoms of hyponatremia

Correct answer: A

Rationale: Spironolactone is a potassium-sparing diuretic, which can lead to hyperkalemia as it helps retain potassium in the body. Therefore, monitoring for signs of hyperkalemia such as muscle weakness, arrhythmias, or ECG changes is crucial to prevent potential complications.

4. The client has undergone a thyroidectomy, and the nurse is providing care. Which assessment finding requires immediate intervention?

• A. Hoarseness and a sore throat.
• B. Difficulty swallowing.
• C. Numbness and tingling around the mouth.
• D. Temperature of 100.2°F (37.9°C).

Correct answer: C

Rationale: Numbness and tingling around the mouth can indicate hypocalcemia, a common complication post-thyroidectomy due to inadvertent parathyroid gland removal. Immediate intervention is required to prevent severe hypocalcemia manifestations like tetany or seizures. Hoarseness and a sore throat are common after a thyroidectomy due to surgical trauma and irritation to the vocal cords, not requiring immediate intervention. Difficulty swallowing can be expected due to postoperative swelling or edema, but it should be monitored closely. A temperature of 100.2°F is a mild fever and may be a normal postoperative response, not necessitating immediate intervention unless accompanied by other concerning symptoms.

5. The healthcare provider is assessing a client with Cushing's syndrome. Which clinical manifestation should the healthcare provider expect to find?

• A. Hyperpigmentation of the skin.
• B. Hypotension.
• C. Moon face and buffalo hump.
• D. Weight loss.

Correct answer: C

Rationale: The correct answer is C: Moon face and buffalo hump. In Cushing's syndrome, excess production of corticosteroids leads to redistribution of fat, particularly in the face (moon face) and between the shoulders (buffalo hump). Hyperpigmentation of the skin is actually associated with Addison's disease, not Cushing's syndrome (choice A). Hypotension is not a typical finding in Cushing's syndrome; instead, hypertension is more commonly seen due to the effects of excess cortisol (choice B). Weight gain, rather than weight loss, is a common symptom of Cushing's syndrome due to the metabolic disturbances caused by excess cortisol (choice D).

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