Nursing Elites

1. A client with a history of deep vein thrombosis (DVT) is receiving warfarin (Coumadin). Which instruction should the nurse provide?

• A. Avoid green leafy vegetables.
• B. Take aspirin for headaches.
• C. Use a soft-bristled toothbrush.
• D. Limit fluid intake to 1 liter per day.

Correct answer: C

Rationale: The correct instruction for a client on warfarin therapy, especially with a history of DVT, is to use a soft-bristled toothbrush. This is crucial to prevent gum bleeding, which is a risk due to the anticoagulant effects of warfarin. Green leafy vegetables are rich in vitamin K, which can interfere with warfarin's effectiveness, so they should be consumed consistently to maintain a balance. Aspirin is not recommended for headaches in clients on warfarin due to the increased risk of bleeding. Limiting fluid intake is not a standard instruction for clients on warfarin therapy.

2. A client with liver cirrhosis and ascites is being treated with spironolactone. What is a key nursing consideration for this medication?

• A. Monitoring for signs of hyperkalemia
• B. Checking for signs of hypoglycemia
• C. Assessing for signs of dehydration
• D. Observing for symptoms of hyponatremia

Correct answer: A

Rationale: Spironolactone is a potassium-sparing diuretic, which can lead to hyperkalemia as it helps retain potassium in the body. Therefore, monitoring for signs of hyperkalemia such as muscle weakness, arrhythmias, or ECG changes is crucial to prevent potential complications.

3. A 50-year-old man presents with severe epigastric pain radiating to his back, nausea, and vomiting. He has a history of heavy alcohol use. Laboratory tests reveal elevated serum amylase and lipase. What is the most likely diagnosis?

• A. Acute cholecystitis
• B. Peptic ulcer disease
• C. Acute pancreatitis
• D. Gastroesophageal reflux disease

Correct answer: C

Rationale: The patient's history of heavy alcohol use, severe epigastric pain radiating to the back, nausea, vomiting, and elevated serum amylase and lipase levels are classic signs of acute pancreatitis. Alcohol consumption is a common predisposing factor for pancreatitis, leading to inflammation of the pancreas. The clinical presentation, along with the laboratory findings, strongly support the diagnosis of acute pancreatitis in this patient.

4. A 65-year-old man presents with weight loss, jaundice, and a palpable mass in the right upper quadrant. Laboratory tests reveal elevated bilirubin and alkaline phosphatase levels. What is the most likely diagnosis?

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

Correct answer: C

Rationale: The combination of weight loss, jaundice, a palpable mass in the right upper quadrant, and elevated bilirubin and alkaline phosphatase levels strongly suggests pancreatic cancer. The presentation is classic for pancreatic malignancy, which commonly presents with obstructive jaundice due to the tumor blocking the common bile duct, leading to elevated bilirubin and alkaline phosphatase levels. Weight loss is a common symptom of advanced pancreatic cancer. The palpable mass in the right upper quadrant corresponds to the location of the pancreas. Gallstones typically manifest with different symptoms, while hepatitis and primary biliary cirrhosis are less likely to present with a palpable mass and weight loss in this scenario.

5. In a patient with chronic kidney disease (CKD) receiving erythropoietin therapy, what laboratory result should the nurse monitor to evaluate the effectiveness of this therapy?

• A. Serum creatinine
• B. White blood cell count
• C. Hemoglobin level
• D. Serum potassium

Correct answer: C

Rationale: The correct answer is C: Hemoglobin level. Erythropoietin therapy is used to stimulate red blood cell production in patients with chronic kidney disease who often develop anemia due to reduced erythropoietin production by the kidneys. Monitoring the hemoglobin level is essential to evaluate the effectiveness of erythropoietin therapy as an increase in hemoglobin indicates improved red blood cell production and better management of anemia in these patients. Serum creatinine, white blood cell count, and serum potassium levels are important parameters to monitor in CKD patients but are not specific indicators of the effectiveness of erythropoietin therapy for managing anemia.

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