Nursing Elites

1. During an admission assessment on an HIV positive client diagnosed with Pneumocystis carinii pneumonia (PCP), which symptoms should the nurse carefully observe the client for?

• A. Weight loss exceeding 10 percent of baseline body weight
• B. Altered mental status and tachypnea
• C. Creamy white patches in the oral cavity
• D. Normal ABGs with wet lung sounds in all lung fields

Correct answer: B

Rationale: The correct answer is B: Altered mental status and tachypnea. These symptoms are indicative of PCP and severe HIV progression. Weight loss exceeding 10 percent of baseline body weight (choice A) may be seen in HIV/AIDS but is not specific to PCP. Creamy white patches in the oral cavity (choice C) are characteristic of oral thrush, which is more commonly associated with Candida infections in HIV patients. Normal ABGs with wet lung sounds in all lung fields (choice D) would not be expected with PCP, as it typically presents with hypoxemia and diffuse bilateral infiltrates on chest imaging.

2. A man calls the hospital and asks to talk with the nurse about his girlfriend who was extremely intoxicated on admission and is receiving services for detoxification. He knows that she is in the facility and asks the nurse about her condition. What is the nurse's best response?

• A. ''I can only report that the client is in satisfactory condition.''
• B. ''Let me give you the telephone number for her room.''
• C. ''I cannot acknowledge if a client is here or not.''
• D. ''I will have the nurse who is working with her call you.''

Correct answer: C

Rationale: The nurse must adhere to confidentiality rules and cannot confirm the presence or condition of the client. Choice A is incorrect because disclosing the client's condition breaches confidentiality. Choice B is wrong as it reveals the client's room number, which is also a breach of confidentiality. Choice D is not the best response as it involves sharing information about the client without verifying the caller's identity or relationship to the client.

3. When taking a health history of a client admitted with acute pancreatitis, which client complaint should be expected?

• A. A low-grade fever and left lower abdominal pain
• B. Severe headache and sweating all the time
• C. Severe mid-epigastric pain after ingesting a heavy meal
• D. Dull, continuous, right lower quadrant pain and nausea

Correct answer: C

Rationale: The correct answer is C: 'Severe mid-epigastric pain after ingesting a heavy meal.' This symptom is characteristic of acute pancreatitis due to inflammation of the pancreas, which often presents with severe pain in the mid-epigastric region that may worsen after eating. Choices A, B, and D describe symptoms that are not typically associated with acute pancreatitis. A low-grade fever and left lower abdominal pain (Choice A) may be more indicative of other conditions like diverticulitis. Severe headache and sweating (Choice B) are commonly seen in conditions like migraines or infections. Dull, continuous, right lower quadrant pain and nausea (Choice D) could be suggestive of appendicitis rather than acute pancreatitis.

4. The nurse is performing a peritoneal dialysis exchange on a client with chronic kidney disease (CKD). Which assessment finding should the nurse report to the healthcare provider?

• A. The appearance of the returning dialysate fluid is cloudy
• B. The client complains of slight shortness of breath during installation
• C. The amount of the returning dialysate fluid is greater than the amount instilled
• D. The client complains of abdominal fullness and cramping during instillation

Correct answer: A

Rationale: Cloudy dialysate fluid can indicate peritonitis, a serious complication of peritoneal dialysis. Peritonitis is an urgent condition that requires immediate evaluation and treatment. Reporting this finding promptly is crucial to prevent further complications. Choices B, C, and D are not indicative of peritonitis and do not require immediate reporting to the healthcare provider. Complaining of slight shortness of breath, having a greater return volume, and experiencing abdominal fullness and cramping are common occurrences during peritoneal dialysis and do not necessarily indicate an emergent issue.

5. The nurse enters the room of a client who is awaiting surgery for appendicitis. The unlicensed assistive personnel (UAP) has helped the client to a position of comfort with the right leg flexed and has applied a heating pad to the client’s abdomen to relieve the client’s pain. Which action should the nurse implement first?

• A. Remove the heating pad.
• B. Reposition the client’s right leg.
• C. Monitor for signs of inflammation.
• D. Assess the client’s pain level.

Correct answer: A

Rationale: The correct action for the nurse to implement first is to remove the heating pad. Heating pads should not be used for suspected appendicitis as they can mask symptoms and potentially worsen inflammation. Choice B is not the priority as the position of comfort chosen by the UAP may be appropriate. Monitoring for signs of inflammation (Choice C) is important but not the initial action to address the immediate issue of the heating pad. Assessing the client's pain level (Choice D) can be done after removing the heating pad to evaluate the effectiveness of pain relief measures.

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