Nursing Elites

1. A 35-year-old man presents with difficulty swallowing, weight loss, and regurgitation of undigested food. A barium swallow shows a 'bird beak' appearance of the lower esophagus. What is the most likely diagnosis?

• A. Esophageal cancer
• B. Achalasia
• C. Peptic stricture
• D. Gastroesophageal reflux disease

Correct answer: B

Rationale: The 'bird beak' appearance on a barium swallow is characteristic of achalasia, a condition where the lower esophageal sphincter fails to relax properly. This leads to difficulty swallowing, weight loss, and regurgitation of undigested food, which are hallmark symptoms of achalasia.

2. 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.

3. While assessing a 70-year-old female client with Alzheimer's disease, the nurse notes deep inflamed cracks at the corners of her mouth. What intervention should the nurse include in this client's plan of care?

• A. Apply a moisturizing cream to the affected areas.
• B. Encourage the client to consume foods rich in vitamin B.
• C. Notify the healthcare provider for further evaluation.
• D. Ensure that the client gets adequate B vitamins in foods or supplements.

Correct answer: D

Rationale: Cracks at the corners of the mouth, known as angular cheilitis, can be a sign of vitamin B deficiency, specifically B2 (riboflavin) or B3 (niacin). The nurse should ensure that the client receives adequate B vitamins through foods rich in these nutrients or supplements to address the deficiency, which can help improve the condition of the client's mouth.

4. An otherwise healthy 45-year-old man presents with severe hematochezia and moderate abdominal cramping since this morning. A barium enema one year ago was normal. On examination, his blood pressure is 120/78 and pulse is 100 while lying; when standing, the blood pressure is 110/76 and pulse is 136. His hematocrit is 34. What is the most likely cause of bleeding?

• A. Diverticular bleed
• B. Duodenal ulcer
• C. Inflammatory bowel disease
• D. Vascular ectasia (watermelon stomach)

Correct answer: B

Rationale: The patient's presentation with hematochezia, moderate abdominal cramping, and hemodynamic changes (increased pulse on standing) suggests an upper gastrointestinal bleed. The drop in blood pressure and rise in pulse rate when standing indicate orthostatic hypotension, which is a sign of significant blood loss. The absence of melena does not rule out an upper GI bleed. Ulcers in the duodenal bulb can erode into the gastroduodenal artery, leading to brisk blood loss. A normal barium enema one year ago makes diverticular bleeding less likely. Inflammatory bowel disease usually does not cause severe acute GI bleeding unless there is ulceration into a vessel. Vascular ectasia, like watermelon stomach, typically presents with chronic blood loss and iron deficiency anemia, more common in older women. The absence of vomiting and the presence of hematochezia make Mallory-Weiss tear less likely in this case.

5. A patient with chronic pain is prescribed gabapentin. What is the primary purpose of this medication?

• A. Relieve neuropathic pain
• B. Reduce inflammation
• C. Enhance opioid analgesia
• D. Suppress cough

Correct answer: A

Rationale: Gabapentin is primarily prescribed to relieve neuropathic pain. It works by stabilizing electrical activity in the nerves, making it effective in managing conditions such as diabetic neuropathy, postherpetic neuralgia, and other forms of chronic pain originating from nerve damage.

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