Nursing Elites

1. A patient with a diagnosis of peptic ulcer disease is prescribed omeprazole. When should the patient take this medication for optimal effectiveness?

• A. With meals
• B. At bedtime
• C. Before meals
• D. After meals

Correct answer: C

Rationale: Omeprazole is best taken before meals for optimal effectiveness in reducing stomach acid production and promoting ulcer healing. Taking it before meals allows the medication to act on the proton pumps before food intake triggers acid production, thereby maximizing its therapeutic benefits. Choices A, B, and D are incorrect because taking omeprazole with meals, at bedtime, or after meals may not align with its mechanism of action, potentially reducing its effectiveness in managing peptic ulcer disease.

2. The sister of a patient diagnosed with BRCA gene-related breast cancer asks the nurse, 'Do you think I should be tested for the gene?' Which response by the nurse is most appropriate?

• A. In most cases, breast cancer is not caused by the BRCA gene.
• B. It depends on how you will feel if the test is positive for the BRCA gene.
• C. There are many things to consider before deciding to have genetic testing.
• D. You should decide first whether you are willing to have a bilateral mastectomy.

Correct answer: C

Rationale: The most appropriate response by the nurse is C: 'There are many things to consider before deciding to have genetic testing.' Genetic testing for BRCA gene mutations is a complex decision that involves various factors such as emotional readiness, potential impact on insurance and employability, and the implications of test results. Option A is incorrect because although most breast cancers are not related to BRCA gene mutations, individuals with these mutations have a significantly higher risk. Option B is not ideal as it oversimplifies the decision-making process by focusing solely on emotional aspects. Option D is incorrect as it implies a predetermined course of action (mastectomy) before even undergoing genetic testing, which is not appropriate.

3. A 55-year-old woman presents with fatigue, pruritus, and jaundice. Laboratory tests reveal elevated bilirubin and alkaline phosphatase levels. Imaging shows dilated intrahepatic bile ducts and a normal common bile duct. What is the most likely diagnosis?

• A. Primary biliary cirrhosis
• B. Primary sclerosing cholangitis
• C. Gallstones
• D. Pancreatic cancer

Correct answer: A

Rationale: The presentation of fatigue, pruritus, and jaundice in a 55-year-old woman, along with elevated bilirubin and alkaline phosphatase levels, and imaging findings of dilated intrahepatic bile ducts and a normal common bile duct, are characteristic of primary biliary cirrhosis. Primary biliary cirrhosis is an autoimmune liver disease that typically affects middle-aged women, leading to progressive destruction of the intrahepatic bile ducts.

4. A 46-year-old man with a history of cirrhosis is brought in by his wife because he has been acting strangely. On examination, he is disoriented, ataxic, and has slurred speech. He is also hyperreflexic. His white blood cell count is normal. His hematocrit is 34%. Coagulation times are elevated. His ammonia level is normal. Which of the following statements regarding his management is correct?

• A. He should be treated with a low-protein diet and lactulose
• B. Lorazepam is not the drug of choice to control his behavior
• C. He should not be placed on gentamicin prophylactically to prevent the development of peritonitis
• D. If the patient complains of pain, acetaminophen should be avoided and nonsteroidal anti-inflammatory agents should be used

Correct answer: A

Rationale: This patient presents with symptoms consistent with hepatic encephalopathy. Despite having a normal ammonia level, he should be treated with lactulose and a low-protein diet as recommended for stage 2 hepatic encephalopathy. The normal ammonia level does not exclude the diagnosis, as it lacks sensitivity and specificity. Medications like lorazepam, gentamicin, and NSAIDs should be avoided due to their potential adverse effects in patients with liver disease. Acetaminophen should also be avoided in such patients.

5. A client with Parkinson's disease is being cared for by a nurse. Which intervention should be included to address the client's bradykinesia?

• A. Encourage daily walking.
• B. Provide thickened liquids to prevent aspiration.
• C. Offer small, frequent meals.
• D. Teach the client to use adaptive utensils.

Correct answer: A

Rationale: Encouraging daily walking is an essential intervention to address bradykinesia in clients with Parkinson's disease. Walking helps improve mobility, flexibility, and coordination, which can help manage the slowness of movement associated with bradykinesia. Providing thickened liquids (Choice B) is more relevant for dysphagia, not bradykinesia. Offering small, frequent meals (Choice C) is related to managing dysphagia and nutritional needs but does not specifically address bradykinesia. Teaching the client to use adaptive utensils (Choice D) is more focused on addressing fine motor skills and grip strength, which are not the primary concerns in bradykinesia.

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