Nursing Elites

1. A client with a history of chronic alcohol abuse is at risk for which of the following conditions?

• A. Liver cirrhosis
• B. Renal failure
• C. Chronic obstructive pulmonary disease (COPD)
• D. Peptic ulcer disease

Correct answer: A

Rationale: Chronic alcohol abuse can lead to liver cirrhosis due to long-term liver damage. Alcohol consumption over time can cause inflammation and scarring of the liver, eventually leading to cirrhosis. This condition can severely impact liver function and may progress to liver failure if not addressed.

2. In a 45-year-old woman with a history of arthritis experiencing severe heartburn and indigestion refractory to antacids, which findings on an esophageal manometry study are consistent with her diagnosis?

• A. Vigorous peristalsis and elevated lower esophageal sphincter (LES) pressure
• B. Absent peristalsis and elevated LES pressure
• C. Absent peristalsis and decreased LES pressure
• D. Vigorous peristalsis and decreased LES pressure

Correct answer: C

Rationale: The correct answer is C: Absent peristalsis and decreased lower esophageal sphincter (LES) pressure. The patient in this scenario has scleroderma esophagus, characterized by atrophy of esophageal smooth muscle, leading to the loss of peristalsis and LES tone. These changes contribute to severe symptoms of gastroesophageal reflux disease (GERD) and esophagitis. Absent peristalsis and decreased LES pressure are typical findings in scleroderma esophagus, contributing to the refractory nature of the patient's symptoms despite antacid use.

3. A client with a history of gout is experiencing an acute attack. Which medication should the nurse expect the healthcare provider to prescribe?

• A. Aspirin.
• B. Allopurinol (Zyloprim).
• C. Colchicine.
• D. Probenecid (Benemid).

Correct answer: C

Rationale: During an acute gout attack, the healthcare provider is likely to prescribe colchicine. Colchicine is commonly used to treat acute gout attacks because it works by reducing inflammation and alleviating pain associated with the condition. It is important to note that aspirin is not recommended for gout treatment and may even exacerbate the symptoms. Allopurinol and probenecid are medications used for long-term management of gout by reducing uric acid levels in the blood, but they are not typically prescribed during an acute attack. Therefore, colchicine is the most appropriate medication for managing an acute gout attack.

4. What physical assessment data should the nurse consider a normal finding for a primigravida client who is 12 hours postpartum?

• A. Soft, spongy fundus.
• B. Saturating two perineal pads per hour.
• C. Pulse rate of 56 BPM.
• D. Unilateral lower leg pain.

Correct answer: C

Rationale: The correct answer is C. A pulse rate of 56 BPM can be considered a normal finding for a primigravida client who is 12 hours postpartum. Postpartum bradycardia can occur due to increased stroke volume and decreased vascular resistance after delivery. It is important for the nurse to monitor the client's vital signs and recognize that a lower pulse rate can be expected in the immediate postpartum period. Choices A, B, and D are incorrect because a soft, spongy fundus may indicate uterine atony, saturating two perineal pads per hour is excessive bleeding, and unilateral lower leg pain could suggest deep vein thrombosis, all of which would require further assessment and intervention.

5. What skin care instructions should the nurse give to a patient receiving external beam radiation therapy for cancer treatment?

• A. Use a heating pad to relieve any pain in the treated area.
• B. Apply alcohol-based lotions to the treated area daily.
• C. Avoid exposing the treated area to sunlight.
• D. Wash the treated area with hot water and strong soap.

Correct answer: C

Rationale: Patients undergoing external beam radiation therapy should be advised to avoid exposing the treated area to sunlight to prevent further skin damage. Heat sources like heating pads should be avoided to prevent burns and irritation to the skin. Alcohol-based lotions can be irritating to the skin and are not recommended. Washing the treated area with lukewarm water and mild soap is preferable to maintain skin integrity and prevent irritation. Therefore, the correct instruction for the patient is to avoid exposing the treated area to sunlight.

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