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 client with coronary artery disease (CAD) is prescribed atorvastatin (Lipitor). Which laboratory value requires immediate intervention?

• A. Total cholesterol of 180 mg/dL.
• B. Low-density lipoprotein (LDL) of 200 mg/dL.
• C. Triglycerides of 150 mg/dL.
• D. High-density lipoprotein (HDL) of 40 mg/dL.

Correct answer: B

Rationale: An LDL level of 200 mg/dL is significantly elevated and requires immediate intervention to reduce the risk of cardiovascular events in a client with coronary artery disease (CAD). High LDL levels contribute to the development and progression of atherosclerosis, which can lead to complications like heart attacks and strokes. Lowering LDL levels is a key goal in managing CAD and preventing further cardiovascular damage. Total cholesterol of 180 mg/dL, triglycerides of 150 mg/dL, and HDL of 40 mg/dL are within acceptable ranges and do not pose an immediate risk that necessitates urgent intervention.

3. In a 45-year-old woman with a history of arthritis experiencing severe heartburn and indigestion refractory to antacids, which findings on an esophageal manometry study are consistent with her diagnosis?

• A. Vigorous peristalsis and elevated lower esophageal sphincter (LES) pressure
• B. Absent peristalsis and elevated LES pressure
• C. Absent peristalsis and decreased LES pressure
• D. Vigorous peristalsis and decreased LES pressure

Correct answer: C

Rationale: The correct answer is C: Absent peristalsis and decreased lower esophageal sphincter (LES) pressure. The patient in this scenario has scleroderma esophagus, characterized by atrophy of esophageal smooth muscle, leading to the loss of peristalsis and LES tone. These changes contribute to severe symptoms of gastroesophageal reflux disease (GERD) and esophagitis. Absent peristalsis and decreased LES pressure are typical findings in scleroderma esophagus, contributing to the refractory nature of the patient's symptoms despite antacid use.

4. The community health nurse is working in a multi-ethnic health center. In what situation should the nurse intervene?

• A. An Asian-American mother reports using cupping to treat an infection, resulting in a pattern of red round marks on her toddler's back.
• B. A Hispanic pregnant client who is often late for appointments arrives late for today's appointment.
• C. A Native-American individual being interviewed will not make direct eye contact when asked about violence in the home.
• D. An African-American infant who is spitting up milk has lost 6 ounces since last week's clinic visit.

Correct answer: D

Rationale: The correct answer is D because losing weight in an infant, especially when combined with spitting up milk, requires immediate intervention to address potential health concerns. Choice A deals with a cultural practice that may not necessarily pose an immediate health risk. Choice B, while important, does not present an immediate health threat. Choice C relates to cultural differences in communication and does not necessarily indicate a need for immediate intervention in terms of health.

5. A client with a history of asthma is prescribed salmeterol (Serevent). Which instruction should the nurse provide?

• A. Use this medication for acute asthma attacks.
• B. Use this medication before using your albuterol inhaler.
• C. Use this medication twice daily for long-term control.
• D. Use this medication as needed for wheezing.

Correct answer: C

Rationale: The correct instruction for a client prescribed salmeterol (Serevent) is to use it twice daily for long-term control. Salmeterol is a long-acting bronchodilator that is not intended for acute asthma attacks or as-needed use for wheezing. Choice A is incorrect because salmeterol is not used for acute asthma attacks. Choice B is incorrect as salmeterol is not meant to replace the albuterol inhaler but rather used for long-term control. Choice D is incorrect because salmeterol should not be used as needed; it is a maintenance medication for asthma.

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