Nursing Elites

1. A 28-year-old woman presents with abdominal pain, diarrhea, and rectal bleeding. She has a history of similar episodes in the past. What is the most likely diagnosis?

• A. Ulcerative colitis
• B. Irritable bowel syndrome
• C. Celiac disease
• D. Diverticulitis

Correct answer: A

Rationale: The constellation of symptoms including abdominal pain, diarrhea, and rectal bleeding in a young woman with a history of similar episodes is highly suggestive of ulcerative colitis. This chronic inflammatory condition primarily affects the colon and rectum, leading to symptoms such as bloody diarrhea, abdominal pain, and urgency. The recurrent nature of her symptoms and the presence of rectal bleeding further support this diagnosis over other conditions listed, such as irritable bowel syndrome, celiac disease, or diverticulitis, which typically do not present with the same combination of symptoms and history.

2. A healthcare professional is participating in the emergency care of a client who has just developed variceal bleeding. What intervention should the healthcare professional anticipate?

• A. Infusion of intravenous heparin
• B. IV administration of albumin
• C. STAT administration of vitamin K by the intramuscular route
• D. IV administration of octreotide

Correct answer: D

Rationale: The correct intervention for variceal bleeding is IV administration of octreotide. Octreotide helps control bleeding from varices by reducing portal blood flow and pressure, which is crucial in managing this emergency situation.

3. An elderly male client reports to the clinic nurse that he is experiencing increasing nocturia with difficulty initiating his urine stream. He reports a weak urine flow and frequent dribbling after voiding. Which nursing action should be implemented?

• A. Obtain a urine specimen for culture and sensitivity.
• B. Encourage the client to schedule a digital rectal exam.
• C. Advise the client to maintain a voiding diary for one week.
• D. Instruct the client in effective techniques for cleansing the glans penis.

Correct answer: B

Rationale: Encouraging the client to schedule a digital rectal exam is the most appropriate nursing action in this situation. This exam can help evaluate for potential prostate enlargement or other issues contributing to the urinary symptoms described by the client. It is important to assess the prostate gland for any abnormalities that may be causing the urinary issues reported by the client.

4. A client who is acutely ill has vigilant oral care included in their plan of care. What factor increases this client's risk for dental caries?

• A. Hormonal changes induced by the stress response leading to an acidic oral environment
• B. Systemic infections commonly affecting the teeth
• C. Intravenous hydration lacking fluoride
• D. Inadequate nutrition and reduced saliva production contributing to cavities

Correct answer: D

Rationale: Inadequate nutrition and decreased saliva production can lead to a conducive environment for the development of dental caries. Without proper nutrition and sufficient saliva, the protective mechanisms against cavities are compromised, making the individual more susceptible to tooth decay.

5. A 65-year-old white female with a history of arthritis, congestive heart failure, and osteoporosis complains of odynophagia for two weeks. A barium swallow shows a moderate-sized crater just above the gastroesophageal junction. What is the least likely contributor to this condition?

• A. NSAIDs
• B. Alendronate
• C. Iron sulfate
• D. Calcium channel blocker

Correct answer: D

Rationale: In this case, the least likely contributor to the condition described is the calcium channel blocker. NSAIDs, alendronate, and iron sulfate have been associated with pill-induced esophagitis, which can present with symptoms like odynophagia and erosions or ulcers on imaging studies. Pill-induced esophagitis is often due to factors like inadequate water intake with the medication, being in a supine position, or underlying motility disorders. Discontinuation of the offending medication typically leads to rapid resolution of esophageal injury. Acid-suppressive therapy may be used to prevent reflux-related damage.

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