Nursing Elites

1. A client with chronic renal failure is prescribed erythropoietin (Epogen). Which outcome indicates that the medication is effective?

• A. Increased urine output.
• B. Improved hemoglobin levels.
• C. Decreased blood pressure.
• D. Stable potassium levels.

Correct answer: B

Rationale: The correct answer is B: Improved hemoglobin levels. Erythropoietin (Epogen) stimulates red blood cell production, leading to an increase in hemoglobin levels in clients with chronic renal failure. Monitoring hemoglobin levels is crucial to assess the effectiveness of erythropoietin therapy in managing anemia associated with chronic renal failure. While increased urine output, decreased blood pressure, and stable potassium levels are important parameters to monitor in clients with renal failure, they are not direct indicators of the effectiveness of erythropoietin therapy.

2. A client's health history is suggestive of inflammatory bowel disease. Which of the following would suggest Crohn disease, rather than ulcerative colitis, as the cause of the client's signs and symptoms?

• A. A pattern of distinct exacerbations and remissions
• B. Severe diarrhea
• C. An absence of blood in stool
• D. Involvement of the rectal mucosa

Correct answer: C

Rationale: In the context of inflammatory bowel disease, the absence of blood in stool is more indicative of Crohn disease. Crohn disease typically presents with non-bloody stools, while ulcerative colitis often involves bloody stools due to continuous mucosal inflammation confined to the colon and rectum.

3. A 35-year-old male patient presents with right upper quadrant pain, fever for the past 48 hours, preceded by new onset jaundice over the past few weeks. He states that he has had diarrhea on and off for several years but never had this investigated. A liver ultrasound is negative for gallstones or evidence of cholecystitis. His lab tests reveal total bilirubin 6.2, alkaline phosphatase 450, AST 150, ALT 120, albumin 2.6. The next diagnostic test of choice would be

• A. Liver biopsy
• B. Magnetic resonance cholangiopancreatography
• C. Hepatitis B surface antigen and hepatitis C RNA assay
• D. Colonoscopy with biopsies

Correct answer: B

Rationale: The patient's presentation with right upper quadrant pain, fever, and jaundice, along with abnormal liver function tests, suggests a biliary tract problem. Given the suspicion of obstructed bile flow and the negative liver ultrasound for gallstones, magnetic resonance cholangiopancreatography (MRCP) is the next appropriate step to evaluate the biliary system and pancreatic ducts. MRCP is non-invasive and can provide detailed images for diagnosis. Liver biopsy is not the preferred initial diagnostic test in this context. Testing for hepatitis B and C would not address the current clinical scenario, and colonoscopy is not indicated for the presenting symptoms.

4. An outcome for treatment of peripheral vascular disease is, 'The client will have decreased venous congestion.' What client behavior would indicate to the nurse that this outcome has been met?

• A. Avoids prolonged sitting or standing.
• B. Avoids trauma and irritation to skin.
• C. Wears protective shoes.
• D. Quits smoking.

Correct answer: A

Rationale: The correct answer is A: 'Avoids prolonged sitting or standing.' In clients with peripheral vascular disease, decreased venous congestion is a desired outcome. Avoiding prolonged sitting or standing helps improve venous return and reduces congestion in the lower extremities, contributing to the achievement of this treatment goal.

5. The nurse is caring for four clients: Client A, who has emphysema and an oxygen saturation of 94%; Client B, with a postoperative hemoglobin of 8.7 g/dL; Client C, newly admitted with a potassium level of 3.8 mEq/L; and Client D, scheduled for an appendectomy with a white blood cell count of 15,000/mm3. What intervention should the nurse implement?

• A. Increase Client A's oxygen to 4 liters per minute via nasal cannula.
• B. Determine if Client B has two units of packed cells available in the blood bank.
• C. Ask the dietitian to add a banana to Client C's breakfast tray.
• D. Inform Client D that surgery is likely to be delayed until the infection is treated.

Correct answer: D

Rationale: A high white blood cell count, as seen in Client D, indicates infection, which may require postponing surgery to treat the infection adequately. It is crucial to address the underlying infection before proceeding with the appendectomy to prevent complications and ensure a successful surgical outcome.

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