Nursing Elites

1. A patient with newly diagnosed lung cancer tells the nurse, 'I don't think I'm going to live to see my next birthday.' Which response by the nurse is best?

• A. Would you like to talk to the hospital chaplain about your feelings?
• B. Can you tell me what it is that makes you think you will die so soon?
• C. Are you afraid that the treatment for your cancer will not be effective?
• D. Do you think that taking an antidepressant medication would be helpful?

Correct answer: B

Rationale: The nurse's initial response should be to collect more assessment data about the patient's statement. The answer beginning 'Can you tell me what it is' is the most open-ended question and will offer the best opportunity for obtaining more data. The answer beginning 'Are you afraid' implies that the patient thinks that the cancer will be immediately fatal, although the patient's statement may not be related to the cancer diagnosis. The remaining two answers offer interventions that may be helpful to the patient, but more assessment is needed to determine whether these interventions are appropriate.

2. A patient is being admitted to the ICU with a severe case of encephalitis. Which of these drugs would the nurse not expect to be prescribed for this condition?

• A. Acyclovir (Zovirax)
• B. Mannitol (Osmitrol)
• C. Lactated Ringer's
• D. Phenytoin (Dilantin)

Correct answer: C

Rationale: In the treatment of encephalitis, medications like Acyclovir and Phenytoin are commonly prescribed. Acyclovir is an antiviral medication used to treat viral infections like herpes simplex virus, which can cause encephalitis. Phenytoin is an antiepileptic drug that may be used to manage seizures associated with encephalitis. Mannitol is a diuretic used to reduce intracranial pressure (ICP) by decreasing cerebral edema. Lactated Ringer's solution, on the other hand, is primarily used in fluid replacement therapy and may not be indicated if a patient is at risk for high ICP, as excessive fluid administration could worsen cerebral edema and increase ICP.

3. A 30-year-old man is being admitted to the hospital for elective knee surgery. Which assessment finding is most important to report to the healthcare provider?

• A. Tympany on percussion of the abdomen
• B. Liver edge 3 cm below the costal margin
• C. Bowel sounds of 20/minute in each quadrant
• D. Aortic pulsations visible in the epigastric area

Correct answer: B

Rationale: The correct answer is 'Liver edge 3 cm below the costal margin.' Normally, the lower border of the liver is not palpable below the ribs, so this finding suggests hepatomegaly, which could indicate an underlying health issue. Tympany on percussion of the abdomen, bowel sounds of 20/minute in each quadrant, and aortic pulsations visible in the epigastric area are all within normal limits for a physical assessment and do not require immediate reporting to the healthcare provider.

4. When assessing a patient suspected to have Hepatitis, a nurse notes the patient's eyes are yellow-tinged. Which of the following diagnostic results would further assist in confirming this diagnosis?

• A. Decreased serum Bilirubin
• B. Elevated serum ALT levels
• C. Low RBC and Hemoglobin with increased WBCs
• D. Increased Blood Urea Nitrogen level

Correct answer: B

Rationale: Elevated serum ALT levels would further confirm the diagnosis of Hepatitis. ALT is a liver enzyme, and hepatitis is a liver disease. Elevated liver enzymes, such as ALT, often indicate liver damage. Choice A, 'Decreased serum Bilirubin,' is incorrect as elevated bilirubin levels are typically seen in hepatitis due to impaired bilirubin metabolism. Choices C and D are unrelated to confirming a diagnosis of hepatitis as they describe findings not specific to liver function or hepatitis. Low RBC and Hemoglobin with increased WBCs (Choice C) suggest a different condition like anemia or infection, not specific to liver disease. Increased Blood Urea Nitrogen level (Choice D) is more indicative of kidney function rather than liver function, thus not helpful in confirming hepatitis.

5. The clinic nurse reviews the record of an infant and notes that the primary health care provider (PHCP) has documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the assessment findings documented in the record, knowing that which sign most likely led the mother to seek health care for the infant?

• A. Diarrhea
• B. Projectile vomiting
• C. Regurgitation of feedings
• D. Constipation

Correct answer: C

Rationale: Hirschsprung's disease, also known as congenital aganglionosis or aganglionic megacolon, is characterized by the absence of ganglion cells in the rectum and other parts of the affected intestine. Clinical manifestations of Hirschsprung's disease include chronic constipation with pellet-like or ribbon-like foul-smelling stools, delayed or absent passage of meconium in the neonatal period, bowel obstruction (especially in the neonatal period), abdominal pain and distention, and failure to thrive. In the case of an infant with suspected Hirschsprung's disease, regurgitation of feedings is a sign that may have led the mother to seek healthcare. This symptom can be associated with the bowel dysfunction and obstruction seen in Hirschsprung's disease. Options A, B, and D are not typically associated with Hirschsprung's disease. Diarrhea is not a common symptom, projectile vomiting is not a typical presentation, and constipation, while a symptom of the disease, is not the sign that would most likely prompt a visit to seek healthcare in an infant suspected of having Hirschsprung's disease.

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