Nursing Elites

1. A client with liver cirrhosis is being educated about managing their condition. Which statement by the client indicates a need for further teaching?

• A. I will avoid drinking alcohol
• B. I need to limit my salt intake
• C. I can take acetaminophen for pain
• D. I should eat a balanced diet

Correct answer: C

Rationale: The correct answer is C. Clients with liver cirrhosis should avoid acetaminophen because it can cause further liver damage. Acetaminophen is metabolized in the liver, and in individuals with liver disease, it can lead to liver toxicity. Therefore, clients with liver cirrhosis should use alternative pain medications that do not affect the liver, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids as prescribed by their healthcare provider. Choices A, B, and D are correct statements for managing liver cirrhosis. Avoiding alcohol helps prevent further liver damage, limiting salt intake helps manage fluid retention and complications like ascites, and eating a balanced diet supports overall health and helps prevent malnutrition.

2. A 50-year-old man presents with severe epigastric pain radiating to his back, nausea, and vomiting. He has a history of heavy alcohol use. Laboratory tests reveal elevated serum amylase and lipase. What is the most likely diagnosis?

• A. Acute cholecystitis
• B. Peptic ulcer disease
• C. Acute pancreatitis
• D. Gastroesophageal reflux disease

Correct answer: C

Rationale: The patient's history of heavy alcohol use, severe epigastric pain radiating to the back, nausea, vomiting, and elevated serum amylase and lipase levels are classic signs of acute pancreatitis. Alcohol consumption is a common predisposing factor for pancreatitis, leading to inflammation of the pancreas. The clinical presentation, along with the laboratory findings, strongly support the diagnosis of acute pancreatitis in this patient.

3. A patient with hypertension is prescribed lisinopril. What side effect should the nurse monitor for?

• A. Hyperkalemia
• B. Hypoglycemia
• C. Bradycardia
• D. Constipation

Correct answer: A

Rationale: When a patient is prescribed lisinopril, an ACE inhibitor, the nurse should monitor for hyperkalemia. Lisinopril can cause hyperkalemia by decreasing aldosterone secretion, which leads to potassium retention in the body. Hyperkalemia is a potential side effect of ACE inhibitors and should be closely monitored, as it can have serious consequences such as affecting cardiac function.

4. In a patient with a history of chronic iron deficiency anemia requiring a recent blood transfusion and an extensive GI work-up, which statement is true based on their medications?

• A. A dedicated small bowel series has a high likelihood of being positive
• B. 81 mg of aspirin per day decreases the benefit of using a COX II inhibitor
• C. The patient should have a provocative arteriogram with heparin infusion to identify the source of blood loss
• D. Hormonal therapy has been shown to be effective in decreasing blood loss due to arteriovenous malformations

Correct answer: B

Rationale: The correct answer is B. Taking even a low dose of aspirin per day, such as 81 mg, can reduce the protective effect on the gastrointestinal mucosa that is gained from using a COX II selective inhibitor. Aspirin can increase the risk of gastrointestinal bleeding, which can counteract the benefits of COX II inhibitors in protecting the stomach lining.

5. A patient with chronic kidney disease (CKD) is prescribed calcium acetate. What is the primary purpose of this medication?

• A. Treat hyperkalemia
• B. Reduce phosphate levels
• C. Lower blood pressure
• D. Increase hemoglobin levels

Correct answer: B

Rationale: The primary purpose of prescribing calcium acetate to a patient with chronic kidney disease (CKD) is to reduce phosphate levels. Calcium acetate binds to dietary phosphate, preventing its absorption and helping to manage hyperphosphatemia commonly seen in CKD patients.

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