Nursing Elites

1. Which goal has the highest priority in the plan of care for a 26-year-old homeless patient admitted with viral hepatitis who has severe anorexia and fatigue?

• A. Increase activity level.
• B. Maintain adequate nutrition
• C. Establish a stable environment
• D. Identify sources of hepatitis exposure

Correct answer: B

Rationale: The highest priority outcome is to maintain adequate nutrition because it is essential for hepatocyte regeneration. In viral hepatitis, the liver is affected, and proper nutrition supports the liver's function and regeneration. While increasing activity level and establishing a stable environment are important, they are not as urgent as ensuring the patient receives proper nutrition. Identifying sources of hepatitis exposure can help prevent future infections, but in the acute phase, the immediate focus should be on providing adequate nutrition to support the patient's recovery.

2. A teen patient is admitted to the hospital by his physician who suspects a diagnosis of acute glomerulonephritis. Which of the following findings is consistent with this diagnosis? Select one that doesn't apply.

• A. Urine specific gravity of 1.040.
• B. Urine output of 350 ml in 24 hours.
• C. Brown ("tea-colored"?) urine.
• D. Generalized edema.

Correct answer: D

Rationale: The correct answer is 'Generalized edema.' Acute glomerulonephritis typically presents with periorbital edema, not generalized edema. Findings in acute glomerulonephritis include dark, smoky, or tea-colored urine (hematuria) due to red blood cells in the urine, elevated blood pressure, and proteinuria. The urine specific gravity may be high due to decreased urine output, but a urine output of 350 ml in 24 hours is extremely low and suggestive of renal impairment. Generalized edema is more commonly associated with nephrotic syndrome, where there is significant proteinuria leading to hypoalbuminemia and subsequent fluid retention in tissues. In acute glomerulonephritis, the edema is usually limited to the face and lower extremities, not generalized.

3. During an intake screening for a patient with hypertension who has been taking ramipril for 4 weeks, which statement made by the patient would be most important for the nurse to pass on to the physician?

• A. ''I get dizzy when I get out of bed.''
• B. ''I'm urinating much more than I used to.''
• C. ''I've been running on the treadmill for 10 minutes each day.''
• D. ''I can't get rid of this cough.''

Correct answer: D

Rationale: The correct answer is ''I can't get rid of this cough.'' Ramipril, an ACE inhibitor, commonly causes a persistent, dry cough as an adverse effect. This symptom can be indicative of bradykinin accumulation caused by ACE inhibitors. It is important for the nurse to inform the physician about this side effect so that a medication change to another class of antihypertensives, such as an ARB, may be considered. Choices A, B, and C are not directly related to the common adverse effects of ramipril and are not as concerning for a patient on this medication.

4. Which fact about diabetes is true?

• A. Only children get type 1 diabetes.
• B. Only adults get type 2 diabetes.
• C. Children and adults can have type 1 diabetes.
• D. Both A and B

Correct answer: C

Rationale: The correct answer is that children and adults can have type 1 diabetes. Although type 1 diabetes is sometimes known as 'childhood diabetes,' it can affect individuals of any age. Type 1 diabetes is not limited to children. While type 2 diabetes is often associated with adults, children can also develop it, especially due to factors like obesity. Choices A and B are incorrect because diabetes is not exclusive to either children or adults; both types of diabetes can affect individuals across different age groups.

5. Which of the following conditions is a contraindication for performing a diagnostic peritoneal lavage?

• A. A client who is 9 weeks pregnant
• B. A client with a femur fracture
• C. A morbidly obese client
• D. A client with hypertension

Correct answer: C

Rationale: Diagnostic peritoneal lavage is contraindicated in morbidly obese clients due to several reasons. Excess body fat in morbidly obese individuals makes it challenging to locate essential landmarks required for the procedure. Additionally, the equipment utilized for the lavage may not be sized appropriately to accommodate an obese individual. Furthermore, morbid obesity places undue stress on the cardiovascular and respiratory systems, increasing the risk of complications when administering anesthetic agents during the procedure. Therefore, performing a diagnostic peritoneal lavage on a morbidly obese client is not recommended. Choice A, a client who is 9 weeks pregnant, is not a contraindication for diagnostic peritoneal lavage. Pregnancy status alone does not preclude the procedure unless there are specific maternal or fetal concerns. Choice B, a client with a femur fracture, is not a contraindication for diagnostic peritoneal lavage. The presence of a femur fracture does not typically affect the ability to perform this diagnostic procedure. Choice D, a client with hypertension, is not a contraindication for diagnostic peritoneal lavage. Hypertension, while a consideration for anesthesia and surgery, does not directly impact the feasibility of performing a diagnostic peritoneal lavage.

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