Nursing Elites

1. When assessing a client with suspected meningitis, which finding is indicative of meningeal irritation?

• A. Brudzinski's sign
• B. Positive Babinski reflex
• C. Kernig's sign
• D. Both A and C

Correct answer: D

Rationale: Both Brudzinski's sign and Kernig's sign are classic signs of meningeal irritation, commonly associated with meningitis. Brudzinski's sign is positive when flexing the neck causes involuntary flexion of the hips and knees due to irritation of the meninges. Kernig's sign is positive when there is pain and resistance with knee extension after hip flexion, indicating meningeal irritation or inflammation. The Babinski reflex, mentioned in choice B, is a test used to assess upper motor neuron damage and is not specific to meningitis. Therefore, choices A and C are the correct options as they are indicative of meningeal irritation in a suspected case of meningitis.

2. The healthcare provider is caring for a patient who is taking warfarin (Coumadin). Which laboratory value should the healthcare provider monitor closely?

• A. Platelet count.
• B. Prothrombin time (PT).
• C. Hemoglobin level.
• D. White blood cell count.

Correct answer: B

Rationale: Corrected Rationale: When caring for a patient on warfarin, monitoring prothrombin time (PT) is crucial. PT helps assess the blood's ability to clot properly, ensuring the patient maintains therapeutic anticoagulation levels while minimizing bleeding risks. Platelet count (Choice A) is important but not the most critical for warfarin therapy. Hemoglobin level (Choice C) and white blood cell count (Choice D) are not directly related to monitoring the effects of warfarin.

3. The client with newly diagnosed osteoporosis is being taught by the nurse about dietary modifications. Which instruction should the nurse include?

• A. Increase your intake of high-calcium foods.
• B. Limit your intake of vitamin D-rich foods.
• C. Avoid foods high in phosphorus.
• D. Increase your intake of high-sodium foods.

Correct answer: A

Rationale: Increasing the intake of high-calcium foods is essential for improving bone density and managing osteoporosis. Calcium is a key mineral necessary for bone health, and individuals with osteoporosis often need higher levels of calcium to help strengthen their bones and prevent further bone loss. Therefore, advising the client to increase their intake of high-calcium foods is the most appropriate dietary modification to support their bone health.

4. A 35-year-old male patient presents with right upper quadrant pain, fever for the past 48 hours, preceded by new onset jaundice over the past few weeks. He states that he has had diarrhea on and off for several years but never had this investigated. A liver ultrasound is negative for gallstones or evidence of cholecystitis. His lab tests reveal total bilirubin 6.2, alkaline phosphatase 450, AST 150, ALT 120, albumin 2.6. The next diagnostic test of choice would be

• A. Liver biopsy
• B. Magnetic resonance cholangiopancreatography
• C. Hepatitis B surface antigen and hepatitis C RNA assay
• D. Colonoscopy with biopsies

Correct answer: B

Rationale: The patient's presentation with right upper quadrant pain, fever, and jaundice, along with abnormal liver function tests, suggests a biliary tract problem. Given the suspicion of obstructed bile flow and the negative liver ultrasound for gallstones, magnetic resonance cholangiopancreatography (MRCP) is the next appropriate step to evaluate the biliary system and pancreatic ducts. MRCP is non-invasive and can provide detailed images for diagnosis. Liver biopsy is not the preferred initial diagnostic test in this context. Testing for hepatitis B and C would not address the current clinical scenario, and colonoscopy is not indicated for the presenting symptoms.

5. A 65-year-old white female with a history of arthritis, congestive heart failure, and osteoporosis complains of odynophagia for two weeks. A barium swallow shows a moderate-sized crater just above the gastroesophageal junction. What is the least likely contributor to this condition?

• A. NSAIDs
• B. Alendronate
• C. Iron sulfate
• D. Calcium channel blocker

Correct answer: D

Rationale: In this case, the least likely contributor to the condition described is the calcium channel blocker. NSAIDs, alendronate, and iron sulfate have been associated with pill-induced esophagitis, which can present with symptoms like odynophagia and erosions or ulcers on imaging studies. Pill-induced esophagitis is often due to factors like inadequate water intake with the medication, being in a supine position, or underlying motility disorders. Discontinuation of the offending medication typically leads to rapid resolution of esophageal injury. Acid-suppressive therapy may be used to prevent reflux-related damage.

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