Nursing Elites

1. A young adult female client is seen in the emergency department for a minor injury following a motor vehicle collision. She states she is very angry at the person who hit her car. What is the best nursing response?

• A. You are lucky to be alive. Be grateful no one was killed.'
• B. I understand your car was not seriously damaged.'
• C. You are upset that this incident has brought you here.'
• D. Have you ever been in the emergency department before?'

Correct answer: C

Rationale: Validating the client's feelings can help her express and manage her emotions effectively.

2. A 35-year-old woman presents with abdominal pain, diarrhea, and weight loss. She has a history of recurrent mouth ulcers and a perianal fistula. What is the most likely diagnosis?

• A. Ulcerative colitis
• B. Irritable bowel syndrome
• C. Crohn's disease
• D. Diverticulitis

Correct answer: C

Rationale: The combination of symptoms including recurrent mouth ulcers, perianal fistula, abdominal pain, diarrhea, and weight loss strongly suggests Crohn's disease. These extra-intestinal manifestations are characteristic of Crohn's disease, a chronic inflammatory condition that can affect any part of the gastrointestinal tract. Ulcerative colitis primarily involves the colon, while irritable bowel syndrome is a functional disorder without the inflammatory component seen in Crohn's disease. Diverticulitis typically presents with localized left lower quadrant pain and is less likely to cause mouth ulcers and perianal fistulas.

3. A 32-year-old woman presents with a 10-month history of an intermittent burning sensation in the epigastrium that is sometimes related to eating. She has heard about bacteria that can cause gastrointestinal (GI) symptoms. She has had no change in her weight and denies dysphagia. Her laboratory tests are normal. Which of the following would you recommend?

• A. Serum qualitative test for H. pylori
• B. Refer for endoscopy
• C. Obtain an upper GI series
• D. Treat her for H. pylori infection

Correct answer: A

Rationale: The patient presents with dyspepsia, described as an intermittent burning sensation in the epigastrium, sometimes related to eating. In individuals under 45 years without warning signs such as anemia, weight loss, or dysphagia, a serum qualitative test for H. pylori is recommended to document H. pylori infection, especially if the patient has not been previously treated. It's important to note that a serum IgG can remain positive post-eradication. If H. pylori-positive patients do not respond to treatment, an endoscopy would be the next step for evaluation. An upper GI series is less sensitive than endoscopy in detecting lesions of the upper GI tract and cannot specifically detect H. pylori. Empiric therapy for H. pylori without confirmation is not recommended.

4. A client with chronic renal failure is prescribed erythropoietin (Epogen). Which outcome indicates that the medication is effective?

• A. Increased urine output.
• B. Improved hemoglobin levels.
• C. Decreased blood pressure.
• D. Stable potassium levels.

Correct answer: B

Rationale: The correct answer is B: Improved hemoglobin levels. Erythropoietin (Epogen) stimulates red blood cell production, leading to an increase in hemoglobin levels in clients with chronic renal failure. Monitoring hemoglobin levels is crucial to assess the effectiveness of erythropoietin therapy in managing anemia associated with chronic renal failure. While increased urine output, decreased blood pressure, and stable potassium levels are important parameters to monitor in clients with renal failure, they are not direct indicators of the effectiveness of erythropoietin therapy.

5. Which assessment finding indicates a client's readiness to leave the nursing unit for a bronchoscopy?

• A. Client denies allergies to contrast media.
• B. Skin prep to insertion site completed.
• C. On-call sedation administered.
• D. Oxygen at 2 L/minute via nasal cannula.

Correct answer: C

Rationale: Administering on-call sedation is crucial before a bronchoscopy to ensure the client is comfortable and adequately prepared for the procedure. Sedation helps reduce anxiety, discomfort, and ensures the client remains still during the bronchoscopy, enabling the healthcare provider to perform the procedure effectively.

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