Nursing Elites

1. A man is prescribed lithium to treat bipolar disorder. The nurse is most concerned about lithium toxicity when he notices which of these assessment findings?

• A. The patient states he had a manic episode a week ago
• B. The patient states he has been having diarrhea every day
• C. The patient presents as severely depressed
• D. The patient has a rash and pruritus on his arms and legs

Correct answer: B

Rationale: The correct answer is when the patient states he has been having diarrhea every day. Persistent diarrhea can lead to dehydration, which can increase the risk of lithium toxicity. The other options, such as a manic episode, severe depression, or rash and pruritus, are not directly associated with an increased risk of lithium toxicity.

2. Which assessment finding would the nurse need to report most quickly to the health care provider regarding a patient with acute pancreatitis?

• A. Nausea and vomiting
• B. Hypotonic bowel sounds
• C. Abdominal tenderness and guarding
• D. Muscle twitching and finger numbness

Correct answer: D

Rationale: The correct answer is muscle twitching and finger numbness. These symptoms indicate hypocalcemia, which can lead to tetany if not promptly addressed with calcium gluconate administration. Nausea and vomiting, hypotonic bowel sounds, and abdominal tenderness and guarding are important findings in acute pancreatitis but do not require the same urgent intervention as hypocalcemia to prevent potential severe complications.

3. When assessing the respiratory system of an older patient, which finding indicates that the nurse should take immediate action?

• A. Weak cough effort
• B. Barrel-shaped chest
• C. Dry mucous membranes
• D. Bilateral crackles at lung bases

Correct answer: D

Rationale: Bilateral crackles at lung bases indicate a potential acute issue like heart failure. Immediate action is necessary in this situation. The nurse should conduct further assessments such as oxygen saturation and inform the healthcare provider promptly. A barrel-shaped chest and hyperresonance to percussion are typical signs of aging and do not require immediate action. A weak cough effort is common in older patients due to age-related changes, and dry mucous membranes are also expected in older individuals. While these findings may warrant further evaluation, they do not demand immediate action like bilateral crackles at lung bases.

4. The clinic nurse reviews the record of an infant and notes that the primary healthcare provider has documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the assessment findings documented in the record, knowing that which sign most likely led the mother to seek healthcare for the infant?

• A. Diarrhea
• B. Projectile vomiting
• C. Regurgitation of feedings
• D. Foul-smelling, ribbon-like stools

Correct answer: D

Rationale: Hirschsprung's disease, also known as congenital aganglionosis or aganglionic megacolon, is a congenital anomaly characterized by an absence of ganglion cells in the rectum and other areas of the affected intestine. A key clinical manifestation of Hirschsprung's disease is chronic constipation that starts in the first month of life, leading to pellet-like or ribbon-like stools that have a foul smell. Another sign is the delayed passage or absence of meconium stool in the neonatal period. In addition to foul-smelling, ribbon-like stools, bowel obstruction (especially in the neonatal period), abdominal pain and distention, and failure to thrive are also common clinical manifestations of this disorder. Options A, B, and C are not typically associated with Hirschsprung's disease, making them incorrect choices in this scenario.

5. Which of the following conditions is a contraindication for performing a diagnostic peritoneal lavage?

• A. A client who is 9 weeks pregnant
• B. A client with a femur fracture
• C. A morbidly obese client
• D. A client with hypertension

Correct answer: C

Rationale: Diagnostic peritoneal lavage is contraindicated in morbidly obese clients due to several reasons. Excess body fat in morbidly obese individuals makes it challenging to locate essential landmarks required for the procedure. Additionally, the equipment utilized for the lavage may not be sized appropriately to accommodate an obese individual. Furthermore, morbid obesity places undue stress on the cardiovascular and respiratory systems, increasing the risk of complications when administering anesthetic agents during the procedure. Therefore, performing a diagnostic peritoneal lavage on a morbidly obese client is not recommended. Choice A, a client who is 9 weeks pregnant, is not a contraindication for diagnostic peritoneal lavage. Pregnancy status alone does not preclude the procedure unless there are specific maternal or fetal concerns. Choice B, a client with a femur fracture, is not a contraindication for diagnostic peritoneal lavage. The presence of a femur fracture does not typically affect the ability to perform this diagnostic procedure. Choice D, a client with hypertension, is not a contraindication for diagnostic peritoneal lavage. Hypertension, while a consideration for anesthesia and surgery, does not directly impact the feasibility of performing a diagnostic peritoneal lavage.

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