Nursing Elites

1. What type of diet is appropriate for a client with chronic cirrhosis?

• A. High calorie, low protein
• B. High protein, high calorie
• C. Low fat, low sodium
• D. High calorie, low sodium

Correct answer: A

Rationale: The correct diet for a client with chronic cirrhosis is high calorie, low protein. Cirrhosis can lead to impaired protein metabolism, making it essential to limit protein intake. High-calorie foods help meet the client's energy needs. Choice B (High protein, high calorie) is incorrect because high protein intake can worsen hepatic encephalopathy. Choice C (Low fat, low sodium) is not the most appropriate diet for cirrhosis as the focus should be on calories and protein. Choice D (High calorie, low sodium) does not address the need to restrict protein intake, which is crucial in cirrhosis.

2. A patient has been diagnosed with Guillain-Barre Syndrome. Which of the following statements is the most applicable when discussing the impairments with Guillain-Barre Syndrome with the patient?

• A. Guillain-Barre Syndrome improves in almost all cases within 5 years.
• B. Guillain-Barre Syndrome causes limited sensation in the abdominal region.
• C. Guillain-Barre Syndrome causes muscle weakness in the legs.
• D. Guillain-Barre Syndrome affects breathing in severe cases.

Correct answer: C

Rationale: The correct statement is that Guillain-Barre Syndrome causes muscle weakness in the legs. This muscle weakness typically starts in the legs and can progress to the upper body. Choice A is incorrect as while most cases do improve, the recovery time can vary. Choice B is incorrect as Guillain-Barre Syndrome primarily affects muscle weakness rather than sensation. Choice D is incorrect as severe cases of Guillain-Barre Syndrome can lead to respiratory muscle weakness, impacting breathing.

3. A client, age 28, was recently diagnosed with Hodgkin's disease. After staging, therapy is planned to include combination radiation therapy and systemic chemotherapy with MOPP"?nitrogen mustard, vincristine (Onconvin), prednisone, and procarbazine. In planning care for this client, the nurse should anticipate which of the following side effects to contribute to a sense of altered body image?

• A. Cushingoid appearance
• B. Alopecia
• C. Temporary or permanent sterility
• D. Pathologic fractures

Correct answer: B

Rationale: The correct answer is B: Alopecia. Chemotherapy drugs like vincristine can cause alopecia, which is hair loss. This side effect can significantly impact a patient's body image. While Cushingoid appearance (A) can be a side effect of long-term steroid use, temporary or permanent sterility (C) may affect a patient's future fertility but not necessarily alter body image. Pathologic fractures (D) are not common side effects of Hodgkin's disease or its treatment and do not directly contribute to a sense of altered body image in the same way as alopecia does.

4. The client is admitted to the hospital following a motor vehicle accident and has sustained a closed chest wound. Which assessment finding is consistent with a flail chest?

• A. Biot's respirations
• B. Sucking sounds during respirations
• C. Paradoxical chest wall movement
• D. Hypotension and bradycardia

Correct answer: C

Rationale: The correct assessment finding consistent with a flail chest is paradoxical chest wall movement. This occurs when a segment of the chest wall moves in the opposite direction to the rest of the chest during respiration. Biot's respirations (Choice A) are a pattern of breathing characterized by groups of quick, shallow inspirations followed by regular or irregular periods of apnea. Sucking sounds during respirations (Choice B) may indicate air entering or leaving the chest cavity through a wound. Hypotension and bradycardia (Choice D) may be present due to other factors such as shock, but they are not specific to a flail chest.

5. Laboratory tests reveal the following electrolyte values for Mr. Smith: Na 135 mEq/L, Ca 8.5 mg/dL, Cl 102 mEq/L, and K 2.0 mEq/L. Which of the following values should the nurse report to the physician because of its potential risk to the client?

• A. Ca
• B. K
• C. Na
• D. Cl

Correct answer: B

Rationale: The correct answer is 'K.' Normal serum potassium levels range between 3.5 and 5.5 mEq/L. Mr. Smith's potassium level of 2.0 mEq/L is significantly below the normal range, indicating hypokalemia, which can lead to serious risks such as cardiac arrhythmias. The levels of sodium (Na), calcium (Ca), and chloride (Cl) are within normal ranges, so they do not pose an immediate risk to the client's health. Therefore, the nurse should report the low potassium level to the physician for prompt intervention.

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