Nursing Elites

1. A 32-year-old woman presents with a 10-month history of an intermittent burning sensation in the epigastrium that is sometimes related to eating. She has heard about bacteria that can cause gastrointestinal (GI) symptoms. She has had no change in her weight and denies dysphagia. Her laboratory tests are normal. Which of the following would you recommend?

• A. Serum qualitative test for H. pylori
• B. Refer for endoscopy
• C. Obtain an upper GI series
• D. Treat her for H. pylori infection

Correct answer: A

Rationale: The patient presents with dyspepsia, described as an intermittent burning sensation in the epigastrium, sometimes related to eating. In individuals under 45 years without warning signs such as anemia, weight loss, or dysphagia, a serum qualitative test for H. pylori is recommended to document H. pylori infection, especially if the patient has not been previously treated. It's important to note that a serum IgG can remain positive post-eradication. If H. pylori-positive patients do not respond to treatment, an endoscopy would be the next step for evaluation. An upper GI series is less sensitive than endoscopy in detecting lesions of the upper GI tract and cannot specifically detect H. pylori. Empiric therapy for H. pylori without confirmation is not recommended.

2. A 55-year-old man presents with jaundice, pruritus, and dark urine. Laboratory tests reveal elevated bilirubin and alkaline phosphatase. Imaging shows dilated intrahepatic bile ducts and a normal common bile duct. What is the most likely diagnosis?

• A. Primary biliary cirrhosis
• B. Primary sclerosing cholangitis
• C. Gallstones
• D. Pancreatic cancer

Correct answer: A

Rationale: The clinical presentation of jaundice, pruritus, dark urine, elevated bilirubin and alkaline phosphatase, along with imaging findings of dilated intrahepatic bile ducts and a normal common bile duct, are characteristic of primary biliary cirrhosis. Primary biliary cirrhosis is an autoimmune liver disease that leads to destruction of intrahepatic bile ducts, causing cholestasis and liver damage. This condition typically presents in middle-aged women but can also affect men, as seen in this case.

3. A young adult female client is seen in the emergency department for a minor injury following a motor vehicle collision. She states she is very angry at the person who hit her car. What is the best nursing response?

• A. You are lucky to be alive. Be grateful no one was killed.'
• B. I understand your car was not seriously damaged.'
• C. You are upset that this incident has brought you here.'
• D. Have you ever been in the emergency department before?'

Correct answer: C

Rationale: Validating the client's feelings can help her express and manage her emotions effectively.

4. A client with schizophrenia is prescribed haloperidol (Haldol). The nurse should monitor the client for which potential side effect?

• A. Tardive dyskinesia.
• B. Orthostatic hypotension.
• C. Photosensitivity.
• D. Hyperglycemia.

Correct answer: A

Rationale: The correct answer is A: Tardive dyskinesia. Haloperidol (Haldol) is an antipsychotic medication that can lead to tardive dyskinesia, a side effect characterized by involuntary, repetitive movements of the face and body. Monitoring for this side effect is crucial to provide timely interventions and prevent further complications.

5. When assessing a male client who is receiving a unit of packed red blood cells (PRBCs), the nurse notes that the infusion was started 30 minutes ago, and 50 ml of blood is left to be infused. The client's vital signs are within normal limits. He reports feeling 'out of breath' but denies any other complaints. What action should the nurse take at this time?

• A. Administer a PRN prescription for diphenhydramine (Benadryl).
• B. Start the normal saline attached to the Y-tubing at the same rate.
• C. Decrease the intravenous flow rate of the PRBC transfusion.
• D. Ask the respiratory therapist to administer PRN albuterol (Ventolin).

Correct answer: C

Rationale: In this scenario, the client is experiencing symptoms of shortness of breath, which could indicate fluid overload from the PRBC transfusion. By decreasing the intravenous flow rate of the transfusion, the nurse can slow down the rate of blood being infused, potentially alleviating the symptoms of fluid overload and shortness of breath. This intervention can help prevent further complications and promote the client's comfort and safety.

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