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 55-year-old man presents with jaundice, pruritus, and dark urine. Laboratory tests reveal elevated bilirubin and alkaline phosphatase. 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 clinical presentation of jaundice, pruritus, dark urine, elevated bilirubin and alkaline phosphatase, along with 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 leads to destruction of intrahepatic bile ducts, causing cholestasis and liver damage. This condition typically presents in middle-aged women but can also affect men, as seen in this case.

3. A client with left-sided heart failure is experiencing dyspnea and orthopnea. Which position should the nurse place the client in to relieve these symptoms?

• A. High Fowler's position.
• B. Supine position.
• C. Trendelenburg position.
• D. Sims' position.

Correct answer: A

Rationale: Placing the client in High Fowler's position is beneficial for individuals with left-sided heart failure experiencing dyspnea and orthopnea. This position helps to reduce venous return, decrease preload, and enhance respiratory function, thereby relieving the symptoms mentioned. Choice B, the supine position, is not recommended as it may exacerbate dyspnea and orthopnea by increasing preload. Choice C, the Trendelenburg position, is incorrect as it involves the feet being positioned higher than the head, which is not suitable for heart failure patients. Choice D, the Sims' position, is a lateral position used for rectal examination and is not indicated for relieving dyspnea and orthopnea in heart failure.

4. When working with a client who has chronic constipation, what should be included in client teaching to promote normal bowel function?

• A. Use glycerin suppositories on a regular basis
• B. Limit physical activity in order to promote bowel peristalsis
• C. Consume high-residue, high-fiber foods
• D. Resist the urge to defecate until the urge becomes intense

Correct answer: C

Rationale: Consuming high-residue, high-fiber foods is essential in promoting normal bowel function and preventing constipation. These foods help add bulk to the stool, making it easier to pass and preventing constipation. Glycerin suppositories may provide short-term relief but are not a long-term solution for chronic constipation. Physical activity actually helps promote bowel peristalsis, so limiting it would not be beneficial. Delaying defecation can lead to stool hardening and worsening constipation.

5. Which signs or symptoms are characteristic of an adult client diagnosed with Cushing's syndrome?

• A. Husky voice and complaints of hoarseness.
• B. Warm, soft, moist, salmon-colored skin.
• C. Visible swelling of the neck, with no pain.
• D. Central-type obesity, with thin extremities.

Correct answer: D

Rationale: Cushing's syndrome is characterized by central-type obesity with thin extremities, often referred to as 'truncal obesity.' This pattern of weight distribution is a key feature of Cushing's syndrome due to excessive cortisol levels, leading to fat accumulation in the face, neck, and abdomen, while the extremities remain relatively thin. The other options listed, such as husky voice, hoarseness, warm, soft, moist, salmon-colored skin, and visible swelling of the neck, are not typical findings associated with Cushing's syndrome.

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