Nursing Elites

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

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

Correct answer: B

Rationale: Furosemide is a loop diuretic that acts by inhibiting sodium and chloride reabsorption in the loop of Henle, leading to increased diuresis. By reducing fluid retention, furosemide helps decrease the workload on the heart in patients with chronic heart failure. This medication does not directly increase cardiac output, decrease heart rate, or lower blood pressure as its primary action.

2. A client with hepatic encephalopathy exhibits confusion, difficulty arousing from sleep, and rigid extremities. Based on these clinical findings, what stage of hepatic encephalopathy should the nurse document?

• A. Stage 1
• B. Stage 2
• C. Stage 3
• D. Stage 4

Correct answer: C

Rationale: Stage 3 hepatic encephalopathy is characterized by confusion, difficulty arousing from sleep, and rigidity of extremities. These symptoms indicate advanced manifestations of hepatic encephalopathy, requiring prompt intervention and monitoring to prevent further neurological deterioration.

3. The client with newly diagnosed hypertension is being taught about lifestyle modifications. Which recommendation should be made?

• A. Increase your intake of saturated fats.
• B. Limit your alcohol intake to two drinks per day.
• C. Engage in at least 150 minutes of moderate exercise per week.
• D. Use table salt liberally to season your food.

Correct answer: C

Rationale: Engaging in at least 150 minutes of moderate exercise per week is a key lifestyle modification recommended for individuals with hypertension. Regular exercise helps manage blood pressure, improve cardiovascular health, and overall well-being. It is important for the client to adopt a healthy lifestyle to control hypertension and reduce the risk of complications.

4. A 46-year-old man with a history of cirrhosis is brought in by his wife because he has been acting strangely. On examination, he is disoriented, ataxic, and has slurred speech. He is also hyperreflexic. His white blood cell count is normal. His hematocrit is 34%. Coagulation times are elevated. His ammonia level is normal. Which of the following statements regarding his management is correct?

• A. He should be treated with a low-protein diet and lactulose
• B. Lorazepam is not the drug of choice to control his behavior
• C. He should not be placed on gentamicin prophylactically to prevent the development of peritonitis
• D. If the patient complains of pain, acetaminophen should be avoided and nonsteroidal anti-inflammatory agents should be used

Correct answer: A

Rationale: This patient presents with symptoms consistent with hepatic encephalopathy. Despite having a normal ammonia level, he should be treated with lactulose and a low-protein diet as recommended for stage 2 hepatic encephalopathy. The normal ammonia level does not exclude the diagnosis, as it lacks sensitivity and specificity. Medications like lorazepam, gentamicin, and NSAIDs should be avoided due to their potential adverse effects in patients with liver disease. Acetaminophen should also be avoided in such patients.

5. A client with liver cirrhosis and ascites is being treated with spironolactone. What is a key nursing consideration for this medication?

• A. Monitoring for signs of hyperkalemia
• B. Checking for signs of hypoglycemia
• C. Assessing for signs of dehydration
• D. Observing for symptoms of hyponatremia

Correct answer: A

Rationale: Spironolactone is a potassium-sparing diuretic, which can lead to hyperkalemia as it helps retain potassium in the body. Therefore, monitoring for signs of hyperkalemia such as muscle weakness, arrhythmias, or ECG changes is crucial to prevent potential complications.

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