Nursing Elites

1. A client with gastroesophageal reflux disease (GERD) has been experiencing severe reflux during sleep. Which recommendation by the nurse is most effective to assist the client?

• A. Losing weight.
• B. Decreasing caffeine intake.
• C. Avoiding large meals.
• D. Raising the head of the bed on blocks.

Correct answer: D

Rationale: The correct answer is to raise the head of the bed on blocks (reverse Trendelenburg position). This elevation helps reduce reflux by using gravity to keep stomach contents from flowing back into the esophagus during sleep. Losing weight (Choice A) could be beneficial in managing GERD, but it may not be as effective for immediate relief during sleep. Decreasing caffeine intake (Choice B) and avoiding large meals (Choice C) are also valuable recommendations to manage GERD; however, they may not specifically address the issue of reflux during sleep as directly and effectively as elevating the head of the bed.

2. The nurse assesses a client with advanced cirrhosis of the liver for signs of hepatic encephalopathy. Which finding would the nurse consider an indication of progressive hepatic encephalopathy?

• A. An increase in abdominal girth.
• B. Hypertension and a bounding pulse.
• C. Decreased bowel sounds.
• D. Difficulty in handwriting.

Correct answer: D

Rationale: Difficulty in handwriting is a common early sign of hepatic encephalopathy. Changes in handwriting can indicate progression or reversal of hepatic encephalopathy leading to coma. Choice (A) is a sign of ascites, not hepatic encephalopathy. Hypertension and a bounding pulse (Choice B) are not typically associated with hepatic encephalopathy. Decreased bowel sounds (Choice C) do not directly indicate an increase in serum ammonia level, which is the primary cause of hepatic encephalopathy.

3. A patient is being treated for shock after a motor vehicle accident. The provider orders 6% dextran 75 to be given intravenously. The nurse should expect which outcome as the result of this infusion?

• A. Decreased urine output
• B. Improved blood oxygenation
• C. Increased interstitial fluid
• D. Stabilization of heart rate and blood pressure

Correct answer: D

Rationale: 6% Dextran 75 is a high molecular-weight colloidal solution used to treat shock from burns or trauma. Colloids like 6% dextran 75 are plasma expanders that help increase blood volume, leading to improved heart rate and blood pressure stabilization. The infusion of plasma expanders does not typically decrease urine output. It primarily aims to stabilize circulation rather than affect blood oxygenation or increase interstitial fluid levels.

4. In the staging process of Hodgkin's disease, what does Stage I indicate?

• A. Involvement of a single lymph node.
• B. Involvement of two or more lymph nodes on the same side of the diaphragm.
• C. Involvement of lymph node regions on both sides of the diaphragm.
• D. Involvement of diffuse disease of one or more extralymphatic organs.

Correct answer: A

Rationale: In the staging process of Hodgkin's disease, Stage I signifies the involvement of a single lymph node. This stage indicates localized disease with the disease being limited to a single lymph node or a group of adjacent nodes. Choices B, C, and D are incorrect because they describe more extensive involvement of lymph nodes, both sides of the diaphragm, or extralymphatic organs, which would correspond to higher stages in the staging system.

5. A client with a history of lung disease is at risk for respiratory acidosis. For which of the following signs and symptoms does the nurse assess this client?

• A. Disorientation and dyspnea
• B. Drowsiness, headache, and tachypnea
• C. Tachypnea, dizziness, and paresthesias
• D. Dysrhythmias and decreased respiratory rate and depth

Correct answer: A

Rationale: The correct answer is A: Disorientation and dyspnea. In respiratory acidosis, the retention of carbon dioxide leads to an increase in carbonic acid, causing the pH of the blood to decrease. This can result in symptoms such as dyspnea (difficulty breathing) due to hypoxia and disorientation due to the effects of hypercapnia (elevated carbon dioxide levels) on the brain. Choice B is incorrect because while drowsiness and tachypnea can be present in respiratory acidosis, headache is not a common symptom. Choice C is incorrect because dizziness and paresthesias are not typical symptoms of respiratory acidosis. Choice D is incorrect because dysrhythmias and a decreased respiratory rate and depth are more commonly associated with respiratory alkalosis, not respiratory acidosis.

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