Nursing Elites

1. A patient is being discharged from the med-surgical unit. The patient has a history of gastritis. The nurse questions the patient on their usual routine at home. Which of these statements would alert the nurse that additional teaching is required?

• A. I avoid NSAIDs. I only take a daily aspirin for my heart health.
• B. I always avoid eating hot and spicy foods.
• C. I will continue taking my antacids with or immediately after meals.
• D. I will only drink coffee once a week, if even that often.

Correct answer: A

Rationale: The correct answer is, 'I avoid NSAIDs. I only take a daily aspirin for my heart health.' Aspirin is classified as an NSAID and can exacerbate existing stomach problems, such as gastritis. Therefore, patients with gastritis should avoid aspirin just like any other NSAID. Choice B, 'I always avoid eating hot and spicy foods,' is a good practice for a patient with gastritis. Choice C, 'I will continue taking my antacids with or immediately after meals,' indicates understanding of the correct timing for antacid use. Choice D, 'I will only drink coffee once a week, if even that often,' shows a suitable limitation of coffee intake, which is beneficial for patients with gastritis.

2. The nurse assesses a patient with chronic obstructive pulmonary disease (COPD) who has been admitted with increasing dyspnea over the last 3 days. Which finding is most important for the nurse to report to the healthcare provider?

• A. Respirations are 36 breaths/minute.
• B. Anterior-posterior chest ratio is 1:1.
• C. Lung expansion is decreased bilaterally.
• D. Hyperresonance to percussion is present.

Correct answer: A

Rationale: The correct answer is 'Respirations are 36 breaths/minute.' An increased respiratory rate is a crucial sign of respiratory distress in patients with COPD, necessitating immediate interventions like oxygen therapy or medications. The other options are common chronic changes seen in COPD patients. Option B, the 'Anterior-posterior chest ratio is 1:1,' is related to the barrel chest commonly seen in COPD due to hyperinflation. Option C, 'Lung expansion is decreased bilaterally,' is expected in COPD due to air trapping. Option D, 'Hyperresonance to percussion is present,' is typical in COPD patients with increased lung volume and air trapping.

3. After assessing Mr. B, what is the initial action of the nurse?

• A. Immediately place the client in a negative-pressure room
• B. Set the client up to receive a bronchoscopy
• C. Contact the physician for antifungal medications
• D. Administer oxygen and assist the client to sit in the semi-Fowler's position

Correct answer: A

Rationale: The first action the nurse should take after assessing Mr. B is to administer oxygen and assist him to sit in the semi-Fowler's position. Administering oxygen helps improve tissue oxygenation, while sitting up in a semi-Fowler's position aids in better breathing and secretion clearance. Placing the client in a negative-pressure room is not the immediate priority unless isolation is needed. Performing a bronchoscopy or contacting the physician for antifungal medications is not the initial step in managing a client with suspected pneumonia.

4. Which response by the nurse best explains the purpose of ranitidine (Zantac) for a patient admitted with bleeding esophageal varices?

• A. The medication will reduce the risk of aspiration.
• B. The medication will inhibit the development of gastric ulcers.
• C. The medication will prevent irritation of the enlarged veins.
• D. The medication will decrease nausea and improve appetite.

Correct answer: C

Rationale: The correct answer is: 'The medication will prevent irritation of the enlarged veins.' Esophageal varices are dilated submucosal veins. The therapeutic action of H2-receptor blockers in patients with esophageal varices is to prevent irritation and bleeding from the varices caused by reflux of acidic gastric contents. While ranitidine can decrease the risk of peptic ulcers, reduce nausea, and help prevent aspiration pneumonia, the primary purpose of H2-receptor blockade in this patient is to prevent irritation and bleeding from the varices, not the other listed effects.

5. Which pathologic condition is described as 'increased intraocular pressure of the eye'?

• A. Detached Retina
• B. Fovea Centralis
• C. Presbyopia
• D. Glaucoma

Correct answer: D

Rationale: The correct answer is Glaucoma. Glaucoma is a condition characterized by increased intraocular pressure in the eye, which can lead to optic nerve damage, vision loss, and blindness if left untreated. Detached Retina (A), Fovea Centralis (B), and Presbyopia (C) are not conditions associated with increased intraocular pressure like Glaucoma. Detached Retina is a separation of the retina from its underlying tissue, Fovea Centralis is a part of the retina responsible for sharp central vision, and Presbyopia is an age-related condition affecting near vision due to the loss of flexibility in the eye's lens.

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