Nursing Elites

1. What is the most appropriate nursing intervention to help alleviate severe abdominal pain in a patient with acute pancreatitis?

• A. Encourage oral intake of clear fluids with electrolytes.
• B. Place the patient in a semi-Fowler's position.
• C. Administer prescribed opioid analgesics.
• D. Apply a cold pack to the abdomen.

Correct answer: C

Rationale: Administering prescribed opioid analgesics is the most appropriate nursing intervention to alleviate severe abdominal pain in a patient with acute pancreatitis. Opioid analgesics help manage severe pain effectively in such cases. Encouraging oral intake of clear fluids with electrolytes is contraindicated due to the need for pancreatic rest and potential exacerbation of symptoms. Placing the patient in a semi-Fowler's position helps reduce pressure on the abdomen, unlike a supine position that can worsen the pain. Applying a cold pack is not recommended as it can potentially increase discomfort and vasoconstriction in acute pancreatitis.

2. A 30-year-old woman presents with fatigue, polyuria, and polydipsia. Laboratory tests reveal hyperglycemia and ketonuria. What is the most likely diagnosis?

• A. Type 1 diabetes mellitus
• B. Type 2 diabetes mellitus
• C. Diabetes insipidus
• D. Hyperthyroidism

Correct answer: A

Rationale: The clinical presentation of a 30-year-old woman with fatigue, polyuria, polydipsia, hyperglycemia, and ketonuria is highly suggestive of type 1 diabetes mellitus. Type 1 diabetes mellitus is characterized by autoimmune destruction of pancreatic beta cells, leading to insulin deficiency and subsequent hyperglycemia. The presence of ketonuria indicates the breakdown of fats for energy due to the lack of insulin. In contrast, type 2 diabetes mellitus typically presents with gradual onset and is often associated with insulin resistance rather than absolute insulin deficiency. Diabetes insipidus is characterized by polyuria and polydipsia but is not associated with hyperglycemia or ketonuria. Hyperthyroidism may present with symptoms like fatigue but does not typically cause hyperglycemia or ketonuria.

3. A 50-year-old man presents with progressive jaundice, dark urine, and pruritus. Imaging reveals a mass in the head of the pancreas. What is the most likely diagnosis?

• A. Pancreatic cancer
• B. Chronic pancreatitis
• C. Gallstones
• D. Primary sclerosing cholangitis

Correct answer: A

Rationale: The presentation of progressive jaundice, dark urine, and pruritus along with a pancreatic mass, particularly in the head of the pancreas, strongly suggests pancreatic cancer as the most likely diagnosis. These symptoms are classic for obstructive jaundice caused by a mass in the head of the pancreas, making pancreatic cancer the most fitting choice.

4. A client with a history of deep vein thrombosis (DVT) is receiving warfarin (Coumadin). Which instruction should the nurse provide?

• A. Avoid green leafy vegetables.
• B. Take aspirin for headaches.
• C. Use a soft-bristled toothbrush.
• D. Limit fluid intake to 1 liter per day.

Correct answer: C

Rationale: The correct instruction for a client on warfarin therapy, especially with a history of DVT, is to use a soft-bristled toothbrush. This is crucial to prevent gum bleeding, which is a risk due to the anticoagulant effects of warfarin. Green leafy vegetables are rich in vitamin K, which can interfere with warfarin's effectiveness, so they should be consumed consistently to maintain a balance. Aspirin is not recommended for headaches in clients on warfarin due to the increased risk of bleeding. Limiting fluid intake is not a standard instruction for clients on warfarin therapy.

5. A male client is admitted to the neurological unit. He has just sustained a C-5 spinal cord injury. Which assessment finding of this client warrants immediate intervention by the nurse?

• A. Is unable to feel sensation in the arms and hands.
• B. Has flaccid upper and lower extremities.
• C. Blood pressure is 110/70 and the apical pulse is 68.
• D. Respirations are shallow, labored, and 14 breaths/minute.

Correct answer: D

Rationale: Respirations that are shallow, labored, and at 14 breaths/minute indicate potential respiratory compromise, which is a critical situation requiring immediate intervention to maintain adequate oxygenation and prevent respiratory failure.

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