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. The healthcare provider is caring for a patient who is taking warfarin (Coumadin). Which laboratory value should the healthcare provider monitor closely?

• A. Platelet count.
• B. Prothrombin time (PT).
• C. Hemoglobin level.
• D. White blood cell count.

Correct answer: B

Rationale: Corrected Rationale: When caring for a patient on warfarin, monitoring prothrombin time (PT) is crucial. PT helps assess the blood's ability to clot properly, ensuring the patient maintains therapeutic anticoagulation levels while minimizing bleeding risks. Platelet count (Choice A) is important but not the most critical for warfarin therapy. Hemoglobin level (Choice C) and white blood cell count (Choice D) are not directly related to monitoring the effects of warfarin.

3. A client is undergoing chemotherapy and is at risk for developing thrombocytopenia. What precaution should the nurse teach the client to minimize the risk of bleeding?

• A. Use a soft-bristled toothbrush.
• B. Engage in daily aerobic exercise.
• C. Take aspirin for headaches.
• D. Use an electric razor for shaving.

Correct answer: A

Rationale: Using a soft-bristled toothbrush is essential for clients at risk of thrombocytopenia to prevent gum bleeding, as their platelet counts may be low. Vigorous brushing with a hard-bristled toothbrush can injure the gums, leading to bleeding, which can be exacerbated in clients with low platelets. Therefore, advising the client to use a soft-bristled toothbrush is a crucial precaution to minimize the risk of bleeding.

4. During a home visit, the nurse should evaluate the adequacy of a client's COPD treatment by assessing for which primary symptom?

• A. Dyspnea
• B. Tachycardia
• C. Unilateral diminished breath sounds
• D. Edema of the ankles

Correct answer: A

Rationale: Assessing for dyspnea is crucial when evaluating COPD treatment effectiveness as it is a primary symptom of the condition. Dyspnea, or difficulty breathing, is a common and distressing symptom in COPD patients. Monitoring the severity of dyspnea can provide valuable insights into the client's response to treatment and disease progression.

5. An 89-year-old male client complains to the nurse that people are whispering behind his back and mumbling when they talk to him. What age-related condition is likely to be occurring with this client?

• A. Delirium
• B. Presbyopia
• C. Presbycusis
• D. Cerebral dysfunction

Correct answer: C

Rationale: The correct answer is C, Presbycusis. Presbycusis is age-related hearing loss that often affects the ability to hear high-pitched sounds, making speech appear mumbled. This condition is common in older adults and can lead to difficulties in understanding conversations, as in the case of the client complaining about people whispering and mumbling.

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