Nursing Elites

1. A patient with chronic heart failure is prescribed carvedilol. What is the primary purpose of this medication?

• A. Increase cardiac output
• B. Reduce fluid retention
• C. Decrease heart rate
• D. Lower blood pressure

Correct answer: C

Rationale: Carvedilol, a beta-blocker, is primarily prescribed in patients with chronic heart failure to decrease heart rate and reduce the workload on the heart. By lowering the heart rate, carvedilol helps the heart function more efficiently and improves symptoms in patients with heart failure.

2. 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.

3. Which client's laboratory value requires immediate intervention by a nurse?

• A. A client with GI bleeding who is receiving a blood transfusion and has a hemoglobin of 7 grams.
• B. A client with pancreatitis who has a fasting glucose of 190 mg/dl today and had 160 mg/dl yesterday.
• C. A client with hepatitis who is jaundiced and has a bilirubin level that is 4 times the normal value.
• D. A client with cancer who has an absolute neutrophil count < 500 today and had 2,000 yesterday.

Correct answer: D

Rationale: The correct answer is D. A sudden drop in neutrophil count to below 500 indicates severe neutropenia, putting the client at high risk for infections. Neutrophils are essential for fighting off infections, and a significant decrease in their count can compromise the client's immune response. Immediate intervention is necessary to prevent the development of serious infections in the client with neutropenia.

4. A 50-year-old man presents with fatigue, arthralgia, and darkening of the skin. Laboratory tests reveal elevated liver enzymes and high serum ferritin levels. What is the most likely diagnosis?

• A. Wilson's disease
• B. Hemochromatosis
• C. Alpha-1 antitrypsin deficiency
• D. Autoimmune hepatitis

Correct answer: B

Rationale: The symptoms of fatigue, arthralgia, and skin darkening, along with elevated liver enzymes and high serum ferritin levels, are characteristic of hemochromatosis, a condition characterized by iron overload. In hemochromatosis, excess iron is deposited in various organs, including the liver, leading to symptoms such as fatigue, joint pain, and skin pigmentation changes. The elevated liver enzymes and high serum ferritin levels seen in this patient further support the diagnosis of hemochromatosis.

5. The nurse has completed the admission assessment of a client and has determined that the client's body mass index (BMI) is 33.5 kg/m2. What health promotion advice should the nurse provide to the client?

• A. It would be very helpful if you could integrate more physical activity into your routine.
• B. You're considered to be overweight, so you should be diligent about maintaining a healthy diet.
• C. You might want to consider some of the surgical options that have been developed for treating obesity.
• D. With your permission, I'd like you to refer to a support group for individuals who live with severe obesity.

Correct answer: A

Rationale: Increasing physical activity is a key component of managing BMI and overall health.

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