Nursing Elites

1. A 48-year-old woman presents with fatigue, pruritus, and jaundice. She has a history of ulcerative colitis. Laboratory tests reveal elevated bilirubin and alkaline phosphatase. What is the most likely diagnosis?

• A. Hepatitis B
• B. Primary biliary cirrhosis
• C. Primary sclerosing cholangitis
• D. Autoimmune hepatitis

Correct answer: C

Rationale: The combination of symptoms (fatigue, pruritus, jaundice) along with a history of ulcerative colitis and elevated bilirubin and alkaline phosphatase levels suggests primary sclerosing cholangitis. Primary sclerosing cholangitis is commonly associated with inflammatory bowel disease, such as ulcerative colitis. It is characterized by inflammation and fibrosis of the bile ducts, leading to cholestasis and elevated alkaline phosphatase and bilirubin levels.

2. What instruction should be provided to a client with a history of myocardial infarction (MI) who is prescribed nitroglycerin?

• A. Take nitroglycerin with food to avoid stomach upset.
• B. Store nitroglycerin tablets in a dark, glass container.
• C. Swallow nitroglycerin tablets whole without chewing.
• D. Discontinue the medication if a headache occurs.

Correct answer: B

Rationale: Nitroglycerin is a medication that should be stored in a dark, glass container to protect it from light and moisture. Exposure to light and moisture can reduce its effectiveness. Storing it in a dark, glass container helps maintain the medication's stability and potency, ensuring that it remains safe and effective for use in emergencies, such as angina attacks.

3. A client with a new diagnosis of diabetes mellitus is learning to self-administer insulin. Which instruction should the nurse include?

• A. Store the insulin in the freezer.
• B. Administer the insulin at the same site each time.
• C. Rotate injection sites within the same region.
• D. Shake the vial vigorously before drawing up the insulin.

Correct answer: C

Rationale: The correct instruction for a client learning to self-administer insulin is to rotate injection sites within the same region. This practice helps prevent lipodystrophy, which is a condition characterized by fat tissue changes due to repeated injections in the same spot, and also ensures consistent absorption of insulin throughout the body. Storing insulin in the freezer is incorrect as it can lead to denaturation of the insulin. Administering the insulin at the same site each time can cause lipodystrophy and inconsistent absorption. Shaking the vial vigorously before drawing up the insulin is also incorrect as it can lead to insulin degradation.

4. When assessing a male client who is receiving a unit of packed red blood cells (PRBCs), the nurse notes that the infusion was started 30 minutes ago, and 50 ml of blood is left to be infused. The client's vital signs are within normal limits. He reports feeling 'out of breath' but denies any other complaints. What action should the nurse take at this time?

• A. Administer a PRN prescription for diphenhydramine (Benadryl).
• B. Start the normal saline attached to the Y-tubing at the same rate.
• C. Decrease the intravenous flow rate of the PRBC transfusion.
• D. Ask the respiratory therapist to administer PRN albuterol (Ventolin).

Correct answer: C

Rationale: In this scenario, the client is experiencing symptoms of shortness of breath, which could indicate fluid overload from the PRBC transfusion. By decreasing the intravenous flow rate of the transfusion, the nurse can slow down the rate of blood being infused, potentially alleviating the symptoms of fluid overload and shortness of breath. This intervention can help prevent further complications and promote the client's comfort and safety.

5. A client who underwent a total hip replacement is receiving discharge teaching from a nurse. Which instruction should the nurse include?

• A. Avoid crossing your legs at the knees.
• B. Sit only in low chairs for comfort.
• C. Bend at the waist to pick up objects.
• D. Sleep on the affected side to prevent discomfort.

Correct answer: A

Rationale: The correct instruction the nurse should include is to avoid crossing the legs at the knees. This advice helps prevent dislocation of the new hip joint, which is a common concern after a total hip replacement surgery. Crossing the legs can place stress on the hip joint and increase the risk of dislocation. It is important for the client to follow this precaution to promote proper healing and reduce complications postoperatively.

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