Nursing Elites

1. A 65-year-old woman presents with difficulty swallowing, weight loss, and a history of long-standing heartburn. She has been on proton-pump inhibitors for years, but her symptoms have worsened. What is the most likely diagnosis?

• A. Peptic stricture
• B. Esophageal cancer
• C. Achalasia
• D. Esophageal spasm

Correct answer: B

Rationale: The presentation of difficulty swallowing, weight loss, and worsening symptoms despite long-term use of proton-pump inhibitors raises suspicion for esophageal cancer, especially in a patient with a history of chronic heartburn. Esophageal cancer should be considered in this scenario due to the concerning symptoms and lack of improvement despite appropriate medical management.

2. The client is prescribed clozapine (Clozaril), and the nurse plans to educate them about its purpose. Which statement should the nurse provide?

• A. It will help you function better in the community.
• B. The medication will help you think more clearly.
• C. You will be able to cope with your symptoms.
• D. It will improve your grooming and hygiene.

Correct answer: B

Rationale: Clozapine (Clozaril) is an antipsychotic medication that is known to improve cognitive function and thought clarity in individuals with schizophrenia. It primarily helps in managing symptoms related to thought processes rather than focusing on community function, coping with symptoms, or grooming and hygiene.

3. A client with type 1 diabetes mellitus is experiencing nausea and vomiting. What advice should the nurse give regarding insulin administration?

• A. Skip your insulin dose until you can eat.
• B. Take your insulin as prescribed, but monitor your blood glucose closely.
• C. Reduce your insulin dose by half.
• D. Only take your long-acting insulin.

Correct answer: B

Rationale: The correct advice for a client with type 1 diabetes mellitus experiencing nausea and vomiting is to take insulin as prescribed but monitor blood glucose closely. It is essential to continue insulin therapy even if not eating normally to prevent complications from high blood sugar levels. Skipping insulin doses can lead to dangerous fluctuations in blood glucose levels. Reducing the insulin dose without proper guidance can also result in uncontrolled blood sugar. Taking only long-acting insulin may not provide adequate coverage for mealtime blood sugar elevation. Therefore, the best course of action is to take prescribed insulin doses while closely monitoring blood glucose levels.

4. The nurse is caring for a client who is receiving chemotherapy. Which laboratory result indicates that the client is at risk for infection?

• A. Hemoglobin level of 12 g/dL.
• B. Platelet count of 150,000/mm3.
• C. White blood cell count of 2,000/mm3.
• D. Serum creatinine level of 1.0 mg/dL.

Correct answer: C

Rationale: A white blood cell count of 2,000/mm3 is low and indicates leukopenia, which increases the client's risk for infection. Hemoglobin level and platelet count are not directly indicative of infection risk. Serum creatinine level is related to kidney function, not infection risk.

5. A male client is admitted to the neurological unit. He has just sustained a C-5 spinal cord injury. Which assessment finding of this client warrants immediate intervention by the nurse?

• A. Is unable to feel sensation in the arms and hands.
• B. Has flaccid upper and lower extremities.
• C. Blood pressure is 110/70 and the apical pulse is 68.
• D. Respirations are shallow, labored, and 14 breaths/minute.

Correct answer: D

Rationale: Respirations that are shallow, labored, and at 14 breaths/minute indicate potential respiratory compromise, which is a critical situation requiring immediate intervention to maintain adequate oxygenation and prevent respiratory failure.

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