Nursing Elites

1. A patient with chronic pain is prescribed a fentanyl patch. What is the most important instruction for the nurse to provide?

• A. Apply the patch to a different site each time.
• B. Change the patch every 72 hours.
• C. Avoid using additional heating pads over the patch.
• D. Remove the patch before showering.

Correct answer: B

Rationale: The most important instruction for the nurse to provide to a patient prescribed a fentanyl patch is to change the patch every 72 hours. This ensures consistent pain control and prevents complications. It is crucial to rotate the application sites to prevent skin irritation or reactions. Using additional heating pads over the patch should be avoided as it can increase the absorption of the medication, leading to overdose or adverse effects. Removing the patch before showering is not necessary as long as the patch is securely in place.

2. A client with peptic ulcer disease is prescribed omeprazole (Prilosec). Which instruction should the nurse include in the client's teaching plan?

• A. Take the medication with food.
• B. Take the medication at bedtime.
• C. Take the medication on an empty stomach.
• D. Take the medication as needed for pain relief.

Correct answer: C

Rationale: The correct instruction for a client prescribed omeprazole (Prilosec) is to take the medication on an empty stomach. This is important for optimal absorption and effectiveness of the medication in treating peptic ulcer disease. Choice A ('Take the medication with food') is incorrect because omeprazole should be taken on an empty stomach. Choice B ('Take the medication at bedtime') is incorrect as it does not align with the optimal timing for omeprazole administration. Choice D ('Take the medication as needed for pain relief') is incorrect because omeprazole is not typically used for immediate pain relief but rather for long-term management of peptic ulcer disease.

3. A client who is 2 days postoperative reports severe pain and swelling in the right leg. The nurse notes that the leg is warm and red. What is the nurse's priority action?

• A. Apply a warm compress to the affected leg.
• B. Elevate the leg on pillows.
• C. Measure the circumference of the leg.
• D. Notify the healthcare provider immediately.

Correct answer: D

Rationale: The nurse's priority action in this situation is to notify the healthcare provider immediately. These symptoms, including severe pain, swelling, warmth, and redness in the leg, are indicative of deep vein thrombosis (DVT), a potentially serious condition. Prompt notification of the healthcare provider is crucial to initiate appropriate diagnostic tests and interventions to prevent complications associated with DVT. Applying a warm compress (Choice A) could worsen the condition by increasing blood flow. Elevating the leg (Choice B) might be contraindicated in DVT as it can dislodge a clot. Measuring the circumference of the leg (Choice C) is not the priority at this time compared to promptly involving the healthcare provider.

4. What is the best therapy for a 65-year-old man with symptoms of regurgitation, chest pain, dysphagia, weight loss, dilated esophagus, and an absent gastric air bubble on CXR?

• A. Proton-pump inhibitor
• B. Endoscopic balloon dilatation
• C. Sucralfate
• D. Esophageal resection

Correct answer: B

Rationale: The patient's presentation and radiologic findings are consistent with achalasia. The absence of a mass on upper endoscopy and CT scan helps rule out secondary causes. Achalasia is best managed with endoscopic balloon dilatation or myotomy. Proton-pump inhibitors are not effective for achalasia. Sucralfate is not a primary treatment for achalasia. Esophageal resection is only considered if malignancy develops. Patients with achalasia may experience chest pain and weight loss due to food accumulation in the dilated esophagus. Endoscopic balloon dilatation is a safe and effective treatment option for improving symptoms in achalasia patients.

5. A 45-year-old woman presents with fatigue, weight gain, and constipation. Laboratory tests reveal high TSH and low free T4 levels. What is the most likely diagnosis?

• A. Hypothyroidism
• B. Hyperthyroidism
• C. Thyroiditis
• D. Thyroid cancer

Correct answer: A

Rationale: The combination of high TSH and low free T4 levels is consistent with hypothyroidism, which matches the patient's symptoms of fatigue, weight gain, and constipation. In hypothyroidism, the thyroid gland does not produce enough thyroid hormones, leading to a decrease in metabolic rate and resulting in these clinical findings.

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