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. Which signs or symptoms are characteristic of an adult client diagnosed with Cushing's syndrome?

• A. Husky voice and complaints of hoarseness.
• B. Warm, soft, moist, salmon-colored skin.
• C. Visible swelling of the neck, with no pain.
• D. Central-type obesity, with thin extremities.

Correct answer: D

Rationale: Cushing's syndrome is characterized by central-type obesity with thin extremities, often referred to as 'truncal obesity.' This pattern of weight distribution is a key feature of Cushing's syndrome due to excessive cortisol levels, leading to fat accumulation in the face, neck, and abdomen, while the extremities remain relatively thin. The other options listed, such as husky voice, hoarseness, warm, soft, moist, salmon-colored skin, and visible swelling of the neck, are not typical findings associated with Cushing's syndrome.

3. An elderly client with congestive heart failure (CHF) is admitted to the hospital. Which laboratory test result should the nurse expect to find?

• A. Elevated serum sodium level.
• B. Decreased brain natriuretic peptide (BNP) level.
• C. Increased serum creatinine level.
• D. Elevated hemoglobin and hematocrit levels.

Correct answer: C

Rationale: In clients with congestive heart failure (CHF), impaired cardiac function can lead to decreased renal perfusion, resulting in elevated serum creatinine levels. Therefore, an increased serum creatinine level is a common laboratory finding in CHF clients, indicating possible renal impairment.

4. A client with a history of myocardial infarction (MI) is prescribed atorvastatin (Lipitor). Which outcome indicates that the medication is effective?

• A. Increased blood pressure.
• B. Lowered cholesterol levels.
• C. Decreased heart rate.
• D. Improved liver function.

Correct answer: B

Rationale: The correct answer is B: Lowered cholesterol levels. Atorvastatin is a medication commonly prescribed to lower cholesterol levels, which is crucial in reducing the risk of further cardiovascular events, including myocardial infarction (MI). Monitoring cholesterol levels is essential to assess the effectiveness of atorvastatin therapy and its role in preventing future cardiac complications. Choices A, C, and D are incorrect because increased blood pressure, decreased heart rate, and improved liver function are not direct indicators of atorvastatin's effectiveness in a client with a history of MI.

5. The nurse is administering sevelamer (RenaGel) during lunch to a client with end-stage renal disease (ESRD). The client asks the nurse to bring the medication later. The nurse should describe which action of RenaGel as an explanation for taking it with meals?

• A. Prevents indigestion associated with the ingestion of spicy foods.
• B. Binds with phosphorus in foods and prevents absorption.
• C. Promotes stomach emptying and prevents gastric reflux.
• D. Buffers hydrochloric acid and prevents gastric erosion.

Correct answer: B

Rationale: Sevelamer (RenaGel) binds with phosphorus in foods to prevent its absorption, which is why it should be taken with meals. By taking RenaGel with meals, it can effectively bind with phosphorus from food, reducing the amount of phosphorus absorbed by the body, thus helping to manage hyperphosphatemia in clients with ESRD. Choices A, C, and D are incorrect because RenaGel's primary action is to bind with phosphorus in foods, not related to preventing indigestion, promoting stomach emptying, or buffering hydrochloric acid.

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