Nursing Elites

1. A client with newly diagnosed hypertension is prescribed enalapril (Vasotec). Which instruction should the nurse provide to the client?

• A. Increase your intake of potassium-rich foods.
• B. Report any persistent cough to your healthcare provider.
• C. Take the medication with a full meal.
• D. Avoid grapefruit juice while taking this medication.

Correct answer: B

Rationale: The correct instruction for the nurse to provide the client taking enalapril (Vasotec) is to report any persistent cough to their healthcare provider. Enalapril can cause a side effect of a persistent cough, and it is essential for the healthcare provider to be notified if this occurs to evaluate the need for a medication adjustment or change. Choices A, C, and D are incorrect. Increasing potassium-rich foods is not specifically related to enalapril use; there is no requirement to take enalapril with a full meal, and avoiding grapefruit juice is more relevant for medications metabolized by the CYP3A4 enzyme, not typically for enalapril.

2. When should the charge nurse intervene based on the observed behavior?

• A. Two staff members are overheard talking about a cure for AIDS outside a client's room.
• B. A hospital transporter is reading a client's history and physical while waiting for an elevator.
• C. A UAP tells a client, 'It's hard to quit drinking but Alcoholics Anonymous helped me.'
• D. Two visitors are discussing a hospitalized client's history of drug abuse in the visitor's lounge.

Correct answer: B

Rationale: The hospital transporter reading a client's history and physical without a legitimate need violates patient confidentiality. This behavior requires immediate intervention to protect the client's privacy and confidentiality rights.

3. What dietary advice should the nurse provide to help reduce the occurrence of hot flashes in a post-menopausal client?

• A. Increase intake of spicy foods.
• B. Limit caffeine and alcohol consumption.
• C. Consume a high-protein diet.
• D. Eat more dairy products.

Correct answer: B

Rationale: Limiting caffeine and alcohol consumption is recommended to help reduce the frequency of hot flashes in post-menopausal individuals. Caffeine and alcohol can trigger hot flashes and worsen their occurrence. Encouraging the client to reduce these stimulants in their diet may help alleviate hot flashes and improve their quality of life.

4. 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.

5. A client with a history of atrial fibrillation is prescribed warfarin (Coumadin). Which laboratory test should the nurse monitor to determine the effectiveness of the medication?

• A. Platelet count.
• B. Prothrombin time (PT) and international normalized ratio (INR).
• C. Activated partial thromboplastin time (aPTT).
• D. Fibrinogen level.

Correct answer: B

Rationale: Prothrombin time (PT) and international normalized ratio (INR) are essential laboratory tests to monitor the effectiveness of warfarin (Coumadin) therapy. These tests help assess the clotting time and the desired anticoagulant effect of the medication. Monitoring PT and INR levels is crucial to ensure that the client is within the therapeutic range, reducing the risk of bleeding or clotting complications associated with warfarin therapy. Platelet count (Choice A) measures the number of platelets in the blood and is not specific for monitoring warfarin therapy. Activated partial thromboplastin time (aPTT) (Choice C) is more commonly used to monitor heparin therapy, not warfarin. Fibrinogen level (Choice D) assesses the amount of fibrinogen in the blood and is not a specific test for monitoring warfarin therapy.

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