Nursing Elites

1. A 45-year-old woman presents with fatigue, pruritus, and jaundice. Laboratory tests reveal elevated bilirubin and alkaline phosphatase levels. Imaging shows a normal common bile duct but dilated intrahepatic bile ducts. What is the most likely diagnosis?

• A. Primary biliary cirrhosis
• B. Primary sclerosing cholangitis
• C. Gallstones
• D. Pancreatic cancer

Correct answer: A

Rationale: Based on the symptoms of fatigue, pruritus, and jaundice, along with elevated bilirubin and alkaline phosphatase levels, and imaging findings of a normal common bile duct but dilated intrahepatic bile ducts, the most likely diagnosis is primary biliary cirrhosis. Primary sclerosing cholangitis presents with different imaging findings, often showing strictures and beading of the bile ducts. Gallstones typically cause obstruction in the biliary system, leading to different symptoms and imaging findings. Pancreatic cancer would present with different clinical features and imaging characteristics.

2. A patient with severe anemia is prescribed erythropoietin. What is the primary action of this medication?

• A. Stimulate white blood cell production
• B. Increase platelet count
• C. Promote red blood cell production
• D. Enhance clotting factor production

Correct answer: C

Rationale: Erythropoietin is a hormone that primarily stimulates the bone marrow to produce more red blood cells. By increasing red blood cell production, erythropoietin helps to improve oxygen delivery to tissues, which is essential in managing anemia. Choices A, B, and D are incorrect because erythropoietin specifically targets red blood cell production and does not have a direct effect on white blood cells, platelets, or clotting factors.

3. A patient with a diagnosis of deep vein thrombosis (DVT) is receiving heparin therapy. Which laboratory test should the nurse monitor to evaluate the effectiveness of the heparin therapy?

• A. Prothrombin time (PT)
• B. Partial thromboplastin time (PTT)
• C. Bleeding time
• D. Platelet count

Correct answer: B

Rationale: The correct answer is B: Partial thromboplastin time (PTT). Heparin affects the intrinsic pathway of the coagulation cascade, which is reflected by changes in the PTT. Monitoring the PTT helps ensure that the patient's blood is within the desired therapeutic range and prevents complications related to clotting or bleeding. Prothrombin time (PT) primarily assesses the extrinsic pathway and is not as sensitive to heparin therapy. Bleeding time and platelet count are not specific tests for monitoring the effectiveness of heparin therapy in DVT.

4. A client with schizophrenia is prescribed haloperidol (Haldol). The nurse should monitor the client for which potential side effect?

• A. Tardive dyskinesia.
• B. Orthostatic hypotension.
• C. Photosensitivity.
• D. Hyperglycemia.

Correct answer: A

Rationale: The correct answer is A: Tardive dyskinesia. Haloperidol (Haldol) is an antipsychotic medication that can lead to tardive dyskinesia, a side effect characterized by involuntary, repetitive movements of the face and body. Monitoring for this side effect is crucial to provide timely interventions and prevent further complications.

5. Which client's laboratory value requires immediate intervention by a nurse?

• A. A client with GI bleeding who is receiving a blood transfusion and has a hemoglobin of 7 grams.
• B. A client with pancreatitis who has a fasting glucose of 190 mg/dl today and had 160 mg/dl yesterday.
• C. A client with hepatitis who is jaundiced and has a bilirubin level that is 4 times the normal value.
• D. A client with cancer who has an absolute neutrophil count < 500 today and had 2,000 yesterday.

Correct answer: D

Rationale: The correct answer is D. A sudden drop in neutrophil count to below 500 indicates severe neutropenia, putting the client at high risk for infections. Neutrophils are essential for fighting off infections, and a significant decrease in their count can compromise the client's immune response. Immediate intervention is necessary to prevent the development of serious infections in the client with neutropenia.

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