Nursing Elites

1. A patient with bipolar disorder is prescribed valproic acid. What is an important side effect for the nurse to monitor?

• A. Hypertension
• B. Liver toxicity
• C. Hyperglycemia
• D. Bradycardia

Correct answer: B

Rationale: The correct answer is B: Liver toxicity. Valproic acid is known to potentially cause liver toxicity. Monitoring liver function tests regularly in patients taking valproic acid is crucial to detect any signs of liver damage early and prevent serious complications.

2. What assessments should the nurse prioritize for a client with portal hypertension admitted to the medical floor?

• A. Assessment of blood pressure and evaluation for headaches and visual changes
• B. Assessment for signs and symptoms of venous thromboembolism
• C. Daily weights and measurement of abdominal girth
• D. Monitoring blood glucose every 4 hours

Correct answer: C

Rationale: In portal hypertension, daily weights and measurement of abdominal girth are crucial assessments to monitor fluid retention and ascites. These assessments help in evaluating the effectiveness of treatment and identifying any worsening of the condition, guiding appropriate interventions. Monitoring blood pressure and assessing for symptoms like headaches and visual changes may be important but are not the priority in this case. Assessing for signs and symptoms of venous thromboembolism is relevant in some situations but not directly related to the primary concerns of portal hypertension.

3. The patient described in the preceding question has a positive H. pylori antibody blood test. She is compliant with the medical regimen you prescribe. Although her symptoms initially respond, she returns to see you six months later with the same symptoms. Which of the following statements is correct?

• A. She is at low risk for reinfection with H. pylori
• B. A positive serum IgG indicates that eradication of H. pylori was successful
• C. The urease breath test is an ideal test to document failure of eradication
• D. Dyspepsia typically worsens with H. pylori eradication

Correct answer: C

Rationale: Reinfection with H. pylori is rare, and the persistence of infection usually indicates poor compliance with the medical regimen or antibiotic resistance. The serum IgG may remain positive indefinitely and cannot be used to determine failure of eradication; however, a decrease in quantitative IgG levels has been utilized to indicate treatment success. If available, either the stool antigen or urease breath test is ideal to document treatment failure due to their high sensitivity, specificity, and ease of performance. The relationship between dyspepsia and H. pylori is controversial, but generally, dyspepsia does not typically improve with H. pylori eradication.

4. A client with chronic kidney disease (CKD) has an arteriovenous (AV) fistula for hemodialysis. Which finding should the nurse report to the healthcare provider immediately?

• A. No bruit or thrill over the AV fistula.
• B. Redness at the site of the AV fistula.
• C. Client's complaint of pain at the AV fistula site.
• D. Swelling of the hand on the side of the AV fistula.

Correct answer: A

Rationale: In a client with a chronic kidney disease who has an arteriovenous (AV) fistula for hemodialysis, the absence of a bruit (a humming sound) or thrill (vibratory sensation) over the AV fistula indicates a potential occlusion. This finding suggests inadequate blood flow through the AV fistula, which is a critical issue requiring immediate intervention to prevent complications such as thrombosis or clot formation. Reporting this absence of bruit or thrill promptly to the healthcare provider is essential to ensure timely assessment and management to maintain vascular access for hemodialysis.

5. A client receiving total parenteral nutrition (TPN) through a central line suddenly develops dyspnea, chest pain, and a drop in blood pressure. What should the nurse do first?

• A. Stop the TPN infusion.
• B. Notify the healthcare provider.
• C. Place the client in Trendelenburg position.
• D. Administer oxygen at 2 liters/minute.

Correct answer: C

Rationale: Placing the client in Trendelenburg position should be the initial action as it can help manage a suspected air embolism, a potential complication of TPN administration. This position helps trap air in the apex of the atrium, reducing the risk of air reaching the pulmonary circulation and causing further harm. Once the client is in a safe position, further actions such as stopping the TPN infusion, notifying the healthcare provider, and administering oxygen can be taken as appropriate.

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