Nursing Elites

1. When a client expresses, 'I don't know how I will go on' while discussing feelings related to a recent loss, the nurse remains silent. What is the most likely reason for the nurse's behavior?

• A. The nurse is indicating disapproval of the statement.
• B. The nurse is showing respect for the client's loss.
• C. Silence is mirroring the client's sadness.
• D. Silence enables the client to contemplate what was expressed.

Correct answer: D

Rationale: In therapeutic communication, silence can offer the client an opportunity to process their emotions and thoughts. By remaining silent, the nurse provides a space for the client to reflect on their own words, facilitating deeper exploration and understanding of their feelings.

2. Which regimen is most effective for treating H. pylori infection?

• A. Metronidazole, bismuth subsalicylate, amoxicillin for 14 days
• B. Clarithromycin and omeprazole for 14 days
• C. Metronidazole, lansoprazole, and clarithromycin for 14 days
• D. Metronidazole, clarithromycin, and omeprazole for 7 days

Correct answer: C

Rationale: Regimen C, which consists of metronidazole, lansoprazole, and clarithromycin for 14 days, is recommended by the FDA as an effective treatment for H. pylori infection. This regimen has been shown to have a high eradication rate and is a standard recommendation in clinical practice guidelines for the management of H. pylori-related conditions.

3. A 50-year-old man presents with progressive jaundice, dark urine, and pruritus. Imaging reveals a mass in the head of the pancreas. What is the most likely diagnosis?

• A. Pancreatic cancer
• B. Chronic pancreatitis
• C. Gallstones
• D. Primary sclerosing cholangitis

Correct answer: A

Rationale: The presentation of progressive jaundice, dark urine, and pruritus along with a pancreatic mass, particularly in the head of the pancreas, strongly suggests pancreatic cancer as the most likely diagnosis. These symptoms are classic for obstructive jaundice caused by a mass in the head of the pancreas, making pancreatic cancer the most fitting choice.

4. A client with myelogenous leukemia is receiving an autologous bone marrow transplantation (BMT). What is the priority intervention that the nurse should implement when the bone marrow is repopulating?

• A. Administer sargramostim (Leukine, Prokine).
• B. Infuse PRBC and platelet transfusions.
• C. Give parenteral prophylactic antibiotics.
• D. Maintain a protective isolation environment.

Correct answer: D

Rationale: Maintaining a protective isolation environment is crucial during the repopulation of bone marrow post-transplant to reduce the risk of infections. The client's immune system is compromised during this period, making them highly susceptible to infections. By implementing protective isolation measures, the nurse can help prevent exposure to pathogens, safeguarding the client's health and supporting the success of the transplantation.

5. 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.

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