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 patient with type 1 diabetes is prescribed insulin glargine. What is the primary characteristic of this insulin?

• A. Rapid-acting
• B. Intermediate-acting
• C. Long-acting
• D. Short-acting

Correct answer: C

Rationale: Insulin glargine is classified as a long-acting insulin. It is designed to provide a consistent level of insulin over approximately 24 hours, helping to keep blood glucose levels stable throughout the day. This long duration of action makes it suitable for basal insulin replacement in patients with type 1 diabetes, providing a background level of insulin to mimic the body's natural release of insulin between meals and overnight.

3. A 68-year-old man with a history of diabetes, hypertension, and coronary artery disease (s/p coronary artery bypass graft two years ago) presents to the emergency room with fevers and left-sided abdominal pain. His physical examination reveals a temperature of 101.5°F, pulse 96, and blood pressure of 135/80. His abdomen is soft with moderate left lower quadrant tenderness. There is no rebound or guarding. Bowel sounds are present. A CT scan is done which reveals inflammation around an area of the left colon. The next step in his workup/management should be

• A. Antibiotic therapy with ciprofloxacin and metronidazole
• B. Referral for urgent colonoscopy
• C. Referral to a surgeon for immediate hemicolectomy
• D. Barium enema

Correct answer: A

Rationale: The patient's presentation is consistent with diverticulitis without evidence of perforation or abscess formation on CT scan. During acute infections, procedures like barium enema and colonoscopy should be avoided to prevent the risk of perforation. Urgent surgery is not indicated initially. The appropriate next step is to start antibiotic therapy aimed at gram-negative aerobes and anaerobes, such as ciprofloxacin and metronidazole, which are the initial treatment of choice for diverticulitis.

4. A client with a newly created ileostomy has not had ostomy output for the past 12 hours and reports worsening nausea. What is the nurse's priority action?

• A. Facilitate a referral to the wound-ostomy-continence (WOC) nurse
• B. Report signs and symptoms of obstruction to the health care provider
• C. Encourage the client to mobilize to enhance mobility
• D. Contact the health care provider to obtain a swab of the stoma for culture

Correct answer: B

Rationale: The nurse's priority action in this situation is to report signs and symptoms of possible obstruction to the healthcare provider. Lack of ostomy output and worsening nausea can indicate a potential obstruction, which requires immediate attention and intervention to prevent complications.

5. A client who has Type 1 diabetes and is at 10-weeks gestation comes to the prenatal clinic complaining of a headache, nausea, sweating, feeling shaky, and being tired all the time. What action should the nurse take first?

• A. Check the blood glucose level.
• B. Draw blood for a Hemoglobin A1C.
• C. Assess urine for ketone levels.
• D. Provide the client with a protein snack.

Correct answer: A

Rationale: The correct action for the nurse to take first is to check the client's blood glucose level. This is crucial to determine if the symptoms are a result of hypoglycemia or hyperglycemia, which requires immediate attention to maintain the client's health and the health of the developing fetus.

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