Nursing Elites

1. A 55-year-old woman presents with fatigue, pruritus, and jaundice. Laboratory tests reveal elevated bilirubin and alkaline phosphatase levels. Imaging shows dilated intrahepatic bile ducts and a normal common bile duct. What is the most likely diagnosis?

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

Correct answer: A

Rationale: The presentation of fatigue, pruritus, and jaundice in a 55-year-old woman, along with elevated bilirubin and alkaline phosphatase levels, and imaging findings of dilated intrahepatic bile ducts and a normal common bile duct, are characteristic of primary biliary cirrhosis. Primary biliary cirrhosis is an autoimmune liver disease that typically affects middle-aged women, leading to progressive destruction of the intrahepatic bile ducts.

2. After performing a paracentesis on a client with ascites, 3 liters of fluid are removed. Which assessment parameter is most critical for the nurse to monitor following the procedure?

• A. Pedal pulses.
• B. Breath sounds.
• C. Gag reflex.
• D. Vital signs.

Correct answer: D

Rationale: Following a paracentesis where a significant amount of fluid is removed, it is crucial to monitor the client's vital signs. This helps in detecting any signs of hypovolemia, such as changes in blood pressure, heart rate, and respiratory rate, which could indicate complications post-procedure. Monitoring the vital signs allows for prompt intervention if there are any deviations from the baseline values.

3. A 28-year-old woman presents with abdominal pain, diarrhea, and rectal bleeding. She has a history of similar episodes in the past. What is the most likely diagnosis?

• A. Ulcerative colitis
• B. Irritable bowel syndrome
• C. Celiac disease
• D. Diverticulitis

Correct answer: A

Rationale: The constellation of symptoms including abdominal pain, diarrhea, and rectal bleeding in a young woman with a history of similar episodes is highly suggestive of ulcerative colitis. This chronic inflammatory condition primarily affects the colon and rectum, leading to symptoms such as bloody diarrhea, abdominal pain, and urgency. The recurrent nature of her symptoms and the presence of rectal bleeding further support this diagnosis over other conditions listed, such as irritable bowel syndrome, celiac disease, or diverticulitis, which typically do not present with the same combination of symptoms and history.

4. The nurse is caring for a client who is receiving chemotherapy. Which laboratory result indicates that the client is at risk for infection?

• A. Hemoglobin level of 12 g/dL.
• B. Platelet count of 150,000/mm3.
• C. White blood cell count of 2,000/mm3.
• D. Serum creatinine level of 1.0 mg/dL.

Correct answer: C

Rationale: A white blood cell count of 2,000/mm3 is low and indicates leukopenia, which increases the client's risk for infection. Hemoglobin level and platelet count are not directly indicative of infection risk. Serum creatinine level is related to kidney function, not infection risk.

5. In which situation is it most important for the registered nurse (RN) working on a medical unit to provide direct supervision?

• A. A graduate nurse needs to access a client's implanted port to start an infusion of Ringer's Lactate.
• B. A postpartum nurse pulled to the unit needs to start a transfusion of packed red blood cells.
• C. A practical nurse is preparing to assist the healthcare provider with a lumbar puncture at the bedside.
• D. An unlicensed assistive personnel is preparing to weigh an obese bedfast client using a bed scale.

Correct answer: A

Rationale: Direct supervision is essential when a complex task, such as accessing an implanted port, is being performed by a less experienced healthcare provider, in this case, a graduate nurse. This oversight ensures patient safety and proper execution of the procedure, especially when it is the nurse's first time performing such a task.

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