Nursing Elites

1. The client is being assessed for possible pernicious anemia. Which finding would support this diagnosis?

• A. A weight loss of 10 pounds in 2 weeks
• B. Complaints of numbness and tingling in the extremities
• C. A red, beefy tongue
• D. A hemoglobin level of 12.0 g/dL

Correct answer: C

Rationale: The correct answer is a red, beefy tongue, which is characteristic of pernicious anemia due to the atrophy of the papillae on the tongue. This finding is known as glossitis. A red, beefy tongue is a classic sign of pernicious anemia. Choice A, weight loss of 10 pounds in 2 weeks, is non-specific and not a typical finding in pernicious anemia. Choice B, complaints of numbness and tingling in the extremities, are more indicative of peripheral neuropathy, a common symptom of vitamin B12 deficiency, which can be seen in pernicious anemia. Choice D, a hemoglobin level of 12.0 g/dL, falls within the normal range and does not specifically point towards pernicious anemia, which is characterized by low hemoglobin levels due to impaired absorption of vitamin B12.

2. A client is 2 days post-operative colon resection. After a coughing episode, the client's wound eviscerates. Which nursing action is most appropriate?

• A. Reinsert the protruding organ and cover with 4x4s
• B. Cover the wound with a sterile 4x4 and ABD dressing
• C. Cover the wound with a sterile saline-soaked dressing
• D. Apply an abdominal binder and manual pressure to the wound

Correct answer: B

Rationale: In the scenario where a client's wound eviscerates, the most appropriate nursing action is to cover the wound with a sterile saline-soaked dressing. Reinserting the protruding organ, as mentioned in choice A, is incorrect because it can lead to further complications requiring the client to return to surgery. Choice B, covering the wound with a sterile 4x4 and ABD dressing, is not ideal as it may not provide adequate protection and moisture for the exposed tissue. Choice D, applying an abdominal binder and manual pressure to the wound, is inappropriate as it does not address the specific needs of wound evisceration. Covering the wound with a sterile saline-soaked dressing helps maintain a moist environment, protects the exposed tissue, and prevents infection, promoting optimal wound healing and reducing the risk of complications.

3. A complication of total parenteral nutrition (TPN) is the development of cholestasis. What is this condition?

• A. an inflammatory process of the extrahepatic bile ducts
• B. an arrest of the normal flow of bile
• C. an inflammation of the gallbladder
• D. the formation of gallstones

Correct answer: B

Rationale: Cholestasis due to TPN administration is an intrahepatic process that interrupts the normal flow of bile. It is characterized by a reduction or stoppage of bile flow. Choice A, an inflammatory process of the extrahepatic bile ducts, refers to cholangitis, not cholestasis. Choice C, an inflammation of the gallbladder, describes cholecystitis, a different condition. Choice D, the formation of gallstones, is not correct as cholestasis is about the flow of bile, not the formation of gallstones.

4. The women's health charge nurse is making assignments for the next shift. The unit is short one staff member and will receive a nurse from the medical-surgical unit. Which group of clients should she assign to the medical-surgical nurse?

• A. Total abdominal hysterectomy, bladder suspension with A&P repair, client with breast reduction
• B. C-section planning discharge, post-partum infection, mastectomy
• C. Vaginal delivery of fetal demise, C-section with pneumonia, 32-week gestation with lymphoma
• D. 28-week gestation of bed rest, post-partum with HELLP syndrome, breast reconstruction

Correct answer: A

Rationale: The correct answer includes clients who have undergone surgical procedures typically managed on a medical-surgical unit. Choice A consists of clients who have had elective surgical procedures such as hysterectomy, bladder suspension with A&P repair, and breast reduction, which are commonly treated in a medical-surgical setting. Choices B, C, and D involve clients with various complications related to childbirth, fetal demise, pneumonia, gestational lymphoma, HELLP syndrome, and bed rest, which are more complex cases requiring specialized care beyond medical-surgical nursing.

5. The physician prescribes captopril (Capoten) 25mg po tid for the client with hypertension. Which of the following adverse reactions can occur with administration of Capoten?

• A. Tinnitus
• B. Persistent cough
• C. Muscle weakness
• D. Diarrhea

Correct answer: B

Rationale: A persistent cough might be related to an adverse reaction to captopril (Capoten). Tinnitus (choice A) and diarrhea (choice D) are not commonly associated adverse reactions of captopril. Muscle weakness (choice C) might occur initially but is not considered a common adverse effect of captopril. Therefore, the correct answer is B, persistent cough, as it is a known adverse reaction to captopril.

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