Nursing Elites

1. A client with cirrhosis of the liver is being cared for by the healthcare team. Which clinical manifestation indicates that the client has developed hepatic encephalopathy?

• A. Asterixis.
• B. Jaundice.
• C. Ascites.
• D. Splenomegaly.

Correct answer: A

Rationale: Asterixis, also known as flapping tremor, is a characteristic sign of hepatic encephalopathy, a severe complication of liver cirrhosis. Hepatic encephalopathy results from the liver's inability to detoxify substances in the body, leading to neurologic manifestations such as changes in mental status, confusion, and asterixis.

2. A client with chronic renal failure is scheduled to receive epoetin alfa (Epogen). Which laboratory result should the nurse review before administering the medication?

• A. Blood urea nitrogen (BUN)
• B. Creatinine clearance
• C. Hemoglobin level
• D. Serum potassium

Correct answer: C

Rationale: The correct answer is to review the hemoglobin level before administering epoetin alfa (Epogen) to assess its effectiveness in stimulating red blood cell production. Hemoglobin level is a crucial indicator to monitor in clients with chronic renal failure receiving this medication. Choice A (Blood urea nitrogen) and Choice B (Creatinine clearance) are commonly monitored in renal failure but are not specifically relevant to assessing the effectiveness of epoetin alfa. Choice D (Serum potassium) is important to monitor due to potential imbalances in renal failure, but it is not directly related to evaluating the effectiveness of epoetin alfa.

3. During a home visit, the nurse should evaluate the adequacy of a client's COPD treatment by assessing for which primary symptom?

• A. Dyspnea
• B. Tachycardia
• C. Unilateral diminished breath sounds
• D. Edema of the ankles

Correct answer: A

Rationale: Assessing for dyspnea is crucial when evaluating COPD treatment effectiveness as it is a primary symptom of the condition. Dyspnea, or difficulty breathing, is a common and distressing symptom in COPD patients. Monitoring the severity of dyspnea can provide valuable insights into the client's response to treatment and disease progression.

4. What instruction should the nurse include in the discharge teaching for a patient with hypothyroidism prescribed levothyroxine?

• A. Take the medication with meals.
• B. Take the medication in the morning on an empty stomach.
• C. Discontinue the medication if you feel better.
• D. Double the dose if a dose is missed.

Correct answer: B

Rationale: The correct instruction for a patient with hypothyroidism prescribed levothyroxine is to take the medication in the morning on an empty stomach to enhance absorption. Taking it with meals can interfere with absorption. Patients should not discontinue the medication without consulting their healthcare provider as it can lead to adverse effects. Doubling the dose if a dose is missed can increase the risk of side effects and overdosage. It is crucial for patients to follow the prescribed dosing schedule and consult their healthcare provider for any concerns or missed doses.

5. A client with heart failure is prescribed digoxin (Lanoxin). Which sign of digoxin toxicity should the nurse teach the client to report?

• A. Increased appetite.
• B. Yellow or blurred vision.
• C. Weight gain.
• D. Nasal congestion.

Correct answer: B

Rationale: Yellow or blurred vision is a hallmark sign of digoxin toxicity. Digoxin toxicity can affect various body systems, but visual disturbances, such as yellow or blurred vision, are important signs that the client should report immediately. Other signs like increased appetite, weight gain, or nasal congestion are not typically associated with digoxin toxicity. Prompt reporting of visual disturbances can help prevent further complications associated with digoxin toxicity.

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