Nursing Elites

1. A 70-year-old man presents with sudden onset of severe abdominal pain. He has a history of atrial fibrillation. Physical examination reveals a soft abdomen with minimal tenderness. What is the most likely diagnosis?

• A. Acute pancreatitis
• B. Mesenteric ischemia
• C. Peptic ulcer disease
• D. Diverticulitis

Correct answer: B

Rationale: The sudden onset of severe abdominal pain in a patient with atrial fibrillation, along with a soft abdomen and minimal tenderness on examination, suggest mesenteric ischemia due to embolic occlusion of the mesenteric arteries. This condition is characterized by a sudden and severe decrease in blood flow to the intestines, leading to abdominal pain and tenderness. Acute pancreatitis typically presents with epigastric pain that may radiate to the back, accompanied by elevated serum amylase and lipase levels. Peptic ulcer disease and diverticulitis usually do not manifest with the sudden onset of severe abdominal pain as described in the case.

2. A client with chronic kidney disease (CKD) is scheduled for a renal biopsy. Which pre-procedure instruction should the nurse provide?

• A. Maintain a low-protein diet for 24 hours before the biopsy.
• B. Avoid taking anticoagulant medications for one week before the biopsy.
• C. Drink plenty of fluids before the procedure.
• D. Take your routine medications with a full glass of water before the biopsy.

Correct answer: B

Rationale: The correct pre-procedure instruction the nurse should provide to a client with chronic kidney disease (CKD) scheduled for a renal biopsy is to avoid taking anticoagulant medications for one week before the biopsy. This instruction is crucial to reduce the risk of bleeding during the procedure, as anticoagulants can increase the chance of bleeding complications. Choices A, C, and D are incorrect because maintaining a low-protein diet, drinking plenty of fluids, or taking routine medications with water are not specifically related to reducing the risk of bleeding associated with a renal biopsy in a client with CKD.

3. A client is being discharged with a new prescription for enoxaparin (Lovenox). Which instruction should the nurse include?

• A. Administer the injection in your thigh.
• B. Do not expel the air bubble from the syringe before injection.
• C. Massage the injection site after administration.
• D. Alternate the injection site between the arms.

Correct answer: B

Rationale: The correct instruction for a client with a prescription for enoxaparin (Lovenox) is not to expel the air bubble from the syringe before injection. This ensures the full dose is delivered without affecting the medication's efficacy. Expelling the air bubble may lead to a loss of medication, resulting in suboptimal treatment. Therefore, it is crucial for the client to follow this instruction to receive the intended therapeutic effect of enoxaparin.

4. A patient with chronic heart failure is prescribed carvedilol. What is the primary purpose of this medication?

• A. Increase cardiac output
• B. Reduce fluid retention
• C. Decrease heart rate
• D. Lower blood pressure

Correct answer: C

Rationale: Carvedilol, a beta-blocker, is primarily prescribed in patients with chronic heart failure to decrease heart rate and reduce the workload on the heart. By lowering the heart rate, carvedilol helps the heart function more efficiently and improves symptoms in patients with heart failure.

5. What nursing intervention can help alleviate pruritus in a client with cirrhosis?

• A. Administering antihistamines
• B. Providing a high-protein diet
• C. Applying emollients to the skin
• D. Encouraging frequent baths with hot water

Correct answer: C

Rationale: Applying emollients to the skin can help alleviate pruritus in clients with cirrhosis. Emollients help soothe and moisturize the skin, reducing the discomfort associated with itching.

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