Nursing Elites

1. Which of the following statements is true about ischemic colitis?

• A. Typically requires colonic resection
• B. Affects the watershed areas of the colon, namely, the splenic flexure, right colon, and rectum
• C. Is only seen in the elderly
• D. Requires colonoscopic intervention

Correct answer: B

Rationale: Ischemic colitis most often results from low-flow states associated with hypotension or poor perfusion. As a result, the vascular watershed areas of the colon, including the splenic flexure, right colon, and rectum, are at highest risk of ischemic injury. Therefore, option B is correct as it accurately identifies the areas commonly affected by ischemic colitis.

2. A 55-year-old woman presents with fatigue, pruritus, and jaundice. Laboratory tests reveal elevated bilirubin and alkaline phosphatase levels. Imaging shows dilated intrahepatic bile ducts and a normal common bile duct. What is the most likely diagnosis?

• A. Primary biliary cirrhosis
• B. Primary sclerosing cholangitis
• C. Gallstones
• D. Pancreatic cancer

Correct answer: A

Rationale: The presentation of fatigue, pruritus, and jaundice in a 55-year-old woman, along with elevated bilirubin and alkaline phosphatase levels, and imaging findings of dilated intrahepatic bile ducts and a normal common bile duct, are characteristic of primary biliary cirrhosis. Primary biliary cirrhosis is an autoimmune liver disease that typically affects middle-aged women, leading to progressive destruction of the intrahepatic bile ducts.

3. A client with acute pancreatitis is admitted to the hospital. What is the priority nursing intervention for this client?

• A. Administering oral pancreatic enzymes
• B. Encouraging a high-protein diet
• C. Maintaining NPO status and administering IV fluids
• D. Providing a low-fat diet

Correct answer: C

Rationale: The priority nursing intervention for a client with acute pancreatitis is to maintain NPO (nothing by mouth) status and administer IV fluids. This approach helps rest the pancreas, decrease pancreatic stimulation, and prevent further exacerbation of the condition. By withholding oral intake and providing IV fluids, the pancreas is given the opportunity to recover and inflammation can be reduced. This intervention is crucial in the acute phase of pancreatitis to support the healing process and prevent complications.

4. When providing dietary instructions to a client with cirrhosis, which dietary restriction is important for the nurse to emphasize?

• A. Low-protein diet
• B. Low-sodium diet
• C. High-fiber diet
• D. High-calcium diet

Correct answer: B

Rationale: A low-sodium diet is crucial for clients with cirrhosis to manage fluid retention and ascites. Excessive sodium intake can worsen fluid accumulation in the body, leading to complications. By restricting sodium intake, the client can help reduce fluid retention and maintain better overall health. Therefore, emphasizing a low-sodium diet is essential in the dietary management of cirrhosis. Choices A, C, and D are not the primary focus for cirrhosis management. While protein restriction may be necessary in advanced stages of liver disease, it is not the main dietary concern in cirrhosis. High-fiber and high-calcium diets are generally beneficial for overall health but are not specifically emphasized in cirrhosis management.

5. A 34-year-old woman presents with intermittent abdominal pain, bloating, and diarrhea. She notes that her symptoms improve with fasting. She has a history of iron deficiency anemia. What is the most likely diagnosis?

• A. Irritable bowel syndrome
• B. Celiac disease
• C. Lactose intolerance
• D. Crohn's disease

Correct answer: B

Rationale: The patient's symptoms of intermittent abdominal pain, bloating, and diarrhea that improve with fasting, along with a history of iron deficiency anemia, are highly suggestive of celiac disease. In celiac disease, gluten ingestion leads to mucosal damage in the small intestine, causing malabsorption of nutrients like iron, leading to anemia. The improvement of symptoms with fasting can be explained by the temporary avoidance of gluten-containing foods. Irritable bowel syndrome typically does not improve with fasting. Lactose intolerance usually presents with symptoms after dairy consumption, not with fasting. Crohn's disease typically presents with more chronic symptoms and is not commonly associated with improvement on fasting.

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