Nursing Elites

1. A patient with asthma is prescribed a corticosteroid inhaler. What is the most important instruction to give to the patient?

• A. Use the inhaler only during asthma attacks.
• B. Rinse the mouth after using the inhaler.
• C. Take a double dose if symptoms worsen.
• D. Avoid using a spacer with the inhaler.

Correct answer: B

Rationale: The most important instruction to give to a patient using a corticosteroid inhaler is to rinse the mouth after each use. This is crucial to prevent the development of oral thrush, a common side effect of corticosteroid inhalers. Failure to rinse the mouth can lead to the overgrowth of yeast in the mouth, causing oral thrush, which can be uncomfortable and require additional treatment. Therefore, reminding patients to rinse their mouth after using the inhaler is essential in preventing this potential complication. Choices A, C, and D are incorrect. Using the inhaler only during asthma attacks may lead to uncontrolled asthma symptoms. Taking a double dose without healthcare provider instruction can result in overdose or side effects. Avoiding a spacer with the inhaler can reduce the effectiveness of delivering the medication to the lungs.

2. The patient described in the preceding questions has a positive H. pylori antibody blood test. She is compliant with the medical regimen you prescribe. Although her symptoms initially respond, she returns to see you six months later with the same symptoms. Which of the following statements is correct?

• A. She is at high risk for reinfection with H. pylori.
• B. A positive serum IgG indicates that eradication of H. pylori was unsuccessful.
• C. The urease breath test is an ideal test to document failure of eradication.
• D. Dyspepsia usually improves with H. pylori eradication.

Correct answer: C

Rationale: Reinfection with H. pylori is rare, and the persistence of infection usually indicates poor compliance with the medical regimen or antibiotic resistance. A positive serum IgG may persist indefinitely and cannot alone determine the failure of eradication. However, a decrease in quantitative IgG levels has been used to confirm treatment success. The urease breath test is recommended to assess the failure of eradication as it can detect the presence of H. pylori in the stomach, indicating treatment failure if positive.

3. 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.

4. A client with chronic kidney disease (CKD) has an arteriovenous (AV) fistula for hemodialysis. Which finding should the nurse report to the healthcare provider immediately?

• A. No bruit or thrill over the AV fistula.
• B. Redness at the site of the AV fistula.
• C. Client's complaint of pain at the AV fistula site.
• D. Swelling of the hand on the side of the AV fistula.

Correct answer: A

Rationale: In a client with a chronic kidney disease who has an arteriovenous (AV) fistula for hemodialysis, the absence of a bruit (a humming sound) or thrill (vibratory sensation) over the AV fistula indicates a potential occlusion. This finding suggests inadequate blood flow through the AV fistula, which is a critical issue requiring immediate intervention to prevent complications such as thrombosis or clot formation. Reporting this absence of bruit or thrill promptly to the healthcare provider is essential to ensure timely assessment and management to maintain vascular access for hemodialysis.

5. A patient with chronic kidney disease (CKD) is prescribed erythropoietin. What is the primary action of this medication?

• A. Stimulate white blood cell production
• B. Increase platelet count
• C. Promote red blood cell production
• D. Enhance clotting factor production

Correct answer: C

Rationale: Erythropoietin primarily stimulates the bone marrow to produce more red blood cells, which helps to improve oxygen delivery to tissues. In chronic kidney disease, patients often develop anemia due to reduced erythropoietin production by the kidneys. By administering exogenous erythropoietin, the deficient hormone is replaced, leading to an increase in red blood cell production and subsequently improving the oxygen-carrying capacity of the blood.

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