Nursing Elites

1. A client with liver failure is at an increased risk of bleeding due to the inability to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function?

• A. Alterations in glucose metabolism
• B. Retention of bile salts
• C. Inadequate production of albumin by hepatocytes
• D. Inability of the liver to use vitamin K

Correct answer: D

Rationale: The correct answer is D. The liver's inability to use vitamin K is the most likely factor contributing to the loss of prothrombin synthesis in liver failure. Vitamin K is essential for the synthesis of prothrombin, a crucial clotting factor. In liver failure, impaired utilization of vitamin K leads to decreased production of prothrombin, increasing the risk of bleeding in affected individuals.

2. A 45-year-old man with a history of chronic heartburn presents with progressive difficulty swallowing solids and liquids. He has lost 10 pounds in the past two months. What is the most likely diagnosis?

• A. Esophageal stricture
• B. Esophageal cancer
• C. Achalasia
• D. Peptic ulcer disease

Correct answer: B

Rationale: In this scenario, the patient's presentation of progressive dysphagia to both solids and liquids, along with significant weight loss, is concerning for esophageal cancer. The history of chronic heartburn further raises suspicion as chronic gastroesophageal reflux disease is a risk factor for the development of esophageal adenocarcinoma. Esophageal stricture could cause dysphagia but is less likely to be associated with significant weight loss. Achalasia typically presents with dysphagia to solids more than liquids and does not commonly cause weight loss. Peptic ulcer disease is less likely to lead to progressive dysphagia and significant weight loss compared to esophageal cancer.

3. A client with hyperthyroidism is prescribed propylthiouracil (PTU). Which instruction should the nurse include in the client's discharge teaching?

• A. Report any signs of infection, such as sore throat or fever, to your healthcare provider.'
• B. Increase your intake of iodine-rich foods, such as seafood and dairy products.'
• C. Take the medication on an empty stomach for better absorption.'
• D. You may experience weight gain and fatigue as side effects of the medication.'

Correct answer: A

Rationale: Propylthiouracil (PTU) can suppress bone marrow function, increasing the risk of infection, so it is important to report signs of infection promptly.

4. A client with a history of hypertension is prescribed hydrochlorothiazide. Which instruction should the nurse include in the client's teaching?

• A. Take this medication in the morning.
• B. Avoid foods high in potassium.
• C. Monitor your blood pressure regularly.
• D. Decrease your intake of high-sodium foods.

Correct answer: C

Rationale: Regular monitoring of blood pressure is crucial for individuals with hypertension to assess the effectiveness of the prescribed medication and to ensure blood pressure is within the target range. This helps in managing hypertension and preventing complications associated with high blood pressure. Choices A, B, and D are incorrect because while taking the medication in the morning may be recommended for some drugs, it is not the key instruction for hydrochlorothiazide. Avoiding foods high in potassium and decreasing high-sodium foods are important dietary considerations for certain conditions, but they are not the immediate focus when starting hydrochlorothiazide.

5. A client with chronic obstructive pulmonary disease (COPD) is experiencing respiratory distress. Which intervention should the nurse implement first?

• A. Administer bronchodilators as prescribed.
• B. Encourage pursed-lip breathing.
• C. Position the client in a high Fowler's position.
• D. Obtain a stat arterial blood gas (ABG) sample.

Correct answer: C

Rationale: In a client with COPD experiencing respiratory distress, the priority intervention should be to position the client in a high Fowler's position. This position helps optimize lung expansion, improve oxygenation, and reduce the work of breathing. Administering bronchodilators and encouraging pursed-lip breathing are important interventions but positioning the client to enhance respiratory function takes precedence in this situation. Obtaining an ABG sample may provide valuable information but is not the initial priority when addressing respiratory distress.

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