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 kidney disease (CKD) is experiencing hyperkalemia. Which intervention should the nurse implement to address this condition?

• A. Administer calcium gluconate.
• B. Encourage a diet high in potassium.
• C. Provide potassium supplements.
• D. Restrict sodium intake.

Correct answer: A

Rationale: Administering calcium gluconate is the appropriate intervention for a client with hyperkalemia. Calcium gluconate helps stabilize the heart by counteracting the effects of high potassium levels and reducing the risk of cardiac complications in individuals with hyperkalemia. Choices B, C, and D are incorrect. Encouraging a diet high in potassium or providing potassium supplements would exacerbate hyperkalemia. Restricting sodium intake is not directly related to addressing hyperkalemia.

3. 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.

4. A 40-year-old woman presents with a history of chronic constipation, bloating, and abdominal pain. She notes that the pain is relieved with defecation. She denies any weight loss, blood in her stools, or nocturnal symptoms. Physical examination and routine blood tests are normal. What is the most likely diagnosis?

• A. Inflammatory bowel disease
• B. Irritable bowel syndrome
• C. Celiac disease
• D. Lactose intolerance

Correct answer: B

Rationale: The patient's symptoms of chronic constipation, bloating, abdominal pain relieved with defecation, absence of weight loss, blood in stools, or nocturnal symptoms, along with normal physical examination and routine blood tests, are indicative of irritable bowel syndrome (IBS). IBS is a functional gastrointestinal disorder characterized by abdominal pain or discomfort and altered bowel habits in the absence of any organic cause. It is a diagnosis of exclusion made based on symptom criteria, and the provided clinical scenario aligns with the typical presentation of IBS.

5. A patient with tuberculosis is started on rifampin. What advice should the nurse provide?

• A. Limit intake of green leafy vegetables.
• B. Expect orange-red discoloration of body fluids.
• C. Avoid exposure to sunlight.
• D. Take the medication with antacids.

Correct answer: B

Rationale: The correct advice for a patient starting rifampin is to expect orange-red discoloration of body fluids. Rifampin can cause harmless orange-red discoloration of body fluids, which may include urine, sweat, saliva, and tears. It is important for the patient to be aware of this side effect as it can stain clothing and contact lenses. Limiting the intake of green leafy vegetables is not necessary with rifampin. Avoiding exposure to sunlight is more commonly associated with other medications like tetracyclines, not rifampin. Taking rifampin with antacids is not recommended as antacids can reduce the absorption of rifampin, decreasing its effectiveness in treating tuberculosis.

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